Postoperative hemoglobin level in patients with femoral neck fracture

The aim of this study was to analyze the changes of hemoglobin levels in patients undergoing fixation for femoral neck fracture.

Peroperative hemoglobin levels of patients who underwent either dynamic hip screw (DHS) fixation (n=74; mean age: 80 years) or hip hemiarthroplasty (n=104; mean age: 84 years) for femoral neck fracture was monitored.

There was a statistically and clinically significant mean drop of 31.1 g/L between the preoperative (D0) and postoperative Day 5 Hb levels (p<0.001), with significant reductions from D0 to Day 1 and Day 1 to Day 2 (p<0.001). At each postoperative measurement, DHS patients had lower hemoglobin values over hemiarthroplasty patients (p=0.046).

The decrease in hemoglobin in the first 24-hour postoperative period (D0 to Day 1) is an underestimation of the ultimate lowest value in hemoglobin found at Day 2. Relying on the Day 1 hemoglobin level could be detrimental to patient care. We propose a method of predicting patients likely to be transfused and recommend a protocol for patients undergoing femoral neck fracture surgery to standardize postoperative hemoglobin monitoring.