[Blood transfusion in patients with pertrochanteric femoral fracture]

The aim of the study was to investigate the pattern of transfusion in patients with pertrochanteric femoral fracture, and to compare the results obtained with literature data.

It was a retrospective study including 246 consecutive patients operated on for pertrochanteric femoral fracture at University Hospital for Traumatology in Zagreb from January 1, 2001 to December 31, 2003. The analysis included the method of operative treatment, type of anesthesia, physical status according to the American Society of Anesthesiology (ASA), preoperative hemoglobin levels, use of thromboprophylaxis, transfusion, and mortality.

There were 246 patients with pertrochanteric femoral fracture; 244 (99.2%) underwent surgery and only 2 (0.8%) were treated conservatively. The method of treatment was DHS in 90.2%, and gamma nail in 8.9% of patients. Most patients were classified as ASA II, III and ASA IV (26.4%, 54.9% and 18.7%, respectively), and most were operated on in spinal anesthesia. Thromboprophylaxis with low molecular weight heparins was administered to 98.4% of patients. The mean preoperative hemoglobin was 120 (88-152) g/L, and estimated blood loss during surgery was 300 (100-500) mL. Transfusion of packed erythrocytes was administered 135 (54.9%) patients, 62 (25.2%) during surgery. Fifteen (6.1%) patients received transfusion of blood plasma.

Fractures in trochanteric region usually occur at age over 60 (80% of patients). Due to the patients' cardiovascular status the "transfusion trigger" remains undefined. Even relatively small alterations of the circulating volume make intraoperative blood pressure control rather challenging.

The preoperative level of hemoglobin, clinical status of the patient, type of surgery, and anesthesia are useful predictors of transfusion therapy in patients with pertrochanteric hip fracture.