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Hidden blood loss and its risk factors after hip reconstruction in children
Jiafei Yang1,2, Hua Jiang2, Huajian Gu2
1School of Clinical Medicine, Guizhou Medical University, Guiyang, China.
Insights
Hidden blood loss is significant after hip reconstruction for developmental dysplasia of the hip. Patient weight and longer surgery times increase this risk, necessitating careful perioperative monitoring.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Surgical Outcomes
Background:
- Limited data exists on hidden blood loss (HBL) in pediatric hip reconstruction.
- Developmental dysplasia of the hip (DDH) surgery can involve substantial, unmeasured blood loss.
Purpose of the Study:
- To quantify HBL following surgical correction of DDH.
- To identify risk factors associated with HBL in pediatric DDH patients.
Main Methods:
- Retrospective analysis of 42 patients (58 hips) undergoing Pemberton and femoral osteotomies.
- Calculation of HBL using the Gross formula based on hematocrit changes.
- Statistical analysis including multivariable linear regression to identify risk factors.
Main Results:
- Mean HBL was 283.06 ± 271.05 mL, representing 70.22% of total blood loss.
- Patient weight and surgical duration were identified as independent risk factors for HBL.
Conclusions:
- Significant HBL occurs post-Pemberton and femoral osteotomies for DDH.
- Increased surgical duration and need for blood transfusion correlate with higher HBL.
- Awareness and monitoring of HBL are crucial for patient safety in DDH surgery.
Objective:
There were few reports in the literature regarding hidden blood loss following surgery for developmental dysplasia of the hip in children. This study aimed to evaluate the volume of hidden blood loss and its risk factors among children undergoing hip reconstruction for developmental dysplasia of the hip.
Methods:
A retrospective analysis of clinical data from 42 patients (58 hips), who underwent Pemberton and femoral osteotomies between March 2020 and March 2023, was conducted. Serial complete blood count assays were conducted on the day of admission and four days post-surgery. Preoperative and postoperative hematocrit levels were documented to calculate hidden blood loss utilizing the Gross formula. Pearson and Spearman correlation analyses, along with multivariable linear regression, were employed to ascertain associations between patient characteristics and hidden blood loss.
Results:
The mean hidden blood loss was recorded as 283.06 ± 271.05 mL, constituting 70.22% of the total blood loss. Multiple linear regression analysis identified weight and surgical duration as independent risk factors contributing to hidden blood loss.
Conclusions:
A relevant amount of postoperative hidden blood loss occurs after Pemberton osteotomy and femoral osteotomy for developmental dysplasia of the hip. Surgeons should be aware that patients who require blood transfusions and have longer surgical durations are at a higher risk of developing more hidden blood loss. Therefore, attention should be given to hidden blood loss to ensure patient safety during the perioperative period for those undergoing Pemberton and femoral osteotomies.
Level Of Evidence:
IV.
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