Predictors of excessive blood loss during operative treatment of hip fractures.

OBJECTIVES

To determine the total blood loss and transfusion needs during operative treatments of hip fracture, and identify predictors of excessive blood loss.

METHOD: A prospective study of 242 consecutive patients operated for hip fractures over a 6 month period. The main outcome measure of blood loss was assessed by blood volume in the drainage system and swab weight. A loss of more than 480 mls was considered as excessive blood loss.

RESULTS

The study consisted of 190 women and 52 men, mean age was 81.6 years (range 44-99). More than one-third of patients (34%) lost more than 480 mls of blood, and mean units transfused per patient was 2.3. Univariate predictors of increased blood loss were patients of American Society of Anaesthesiology (ASA) grade III and IV, patients at risk of cerebral or cardiac ischemia from volume depletion as defined by the American College of Physicians, patients with two or more pre-existing medical conditions and patients who had a hemiarthroplasty carried out. However, with subsequent multivariate analysis, patients who had undergone a hemiarthroplasty and those at risk predicted increased blood loss.

CONCLUSION

Pre-operative characteristics can help determine which patients should have either blood requested on the day of surgery (group and cross-match) or the customary group and save policy.