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Early Acetabular Fracture Repair Through an Anterior Approach Is Associated With Increased Blood Loss
Michael Ambrose1,2, Jeff E Schulman1, Christopher Kuenze3
1Department of Orthopedic Surgery, Inova Fairfax Medical Campus, Falls Church, VA.
Objectives:
To determine whether the timing of acetabular fracture fixation through an anterior approach influences estimated and calculated perioperative blood loss.
Design:
Retrospective cohort study.
Setting:
Level 1 trauma center from 2013 to 2021.
Patient Selection Criteria:
Patients aged ≥18 years treated with acetabular fracture fixation through an anterior-based approach.
Outcome Measures And Comparisons:
The primary outcome was calculated blood loss (CBL). Secondary outcomes were estimated blood loss reported by surgeon and anesthesia, and blood transfusion requirements. Comparisons of blood loss were made at discrete postinjury time thresholds (24, 36, and 48 hours) and on a continuous basis.
Results:
One hundred eight patients were studied. The mean age was 65 years, and 73% of patients were male. Earlier fixation of acetabular fractures resulted in greater CBL and estimated blood loss (surgeon and anesthesia) compared with later fixation when analyzed on a continuum and at specific time points (24, 36, and 48 hours). Mean CBL in patients treated earlier (<48 hours, 2539 ± 1194 mL) was significantly greater than those treated later (≥48 hours, 1625 ± 909 mL; P < 0.001). Fracture repair before 48 hours postinjury was associated with a 3 times greater risk of >2000 mL of CBL ( P = 0.006). This did not result in differences in transfusion rates between groups at 24 hours ( P = 0.518), 36 hours ( P = 1.000), or 48 hours ( P = 0.779).
Conclusions:
Delaying fixation of acetabular fractures treated through an anterior approach for 48 hours postinjury may significantly reduce perioperative blood loss.
Level Of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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