Top

Journal of Orthopaedic Surgery and Research

Published in:

Open Access 01-12-2021 | Hip-TEP | Systematic review

Haemoglobin and transfusions in elderly patients with hip fractures: the effect of a dedicated orthogeriatrician

Authors: Marco Quaranta, Luca Miranda, Francesco Oliva, Filippo Migliorini, Gabriela Pezzuti, Nicola Maffulli

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2021

Abstract

Background

Hip fractures are common in elderly patients, in whom it is important to monitor blood loss; however, unnecessary transfusions should be avoided. The primary objective of this study was to assess whether the employment of a dedicated orthogeriatrician in an Orthopaedic Department allows to optimise the clinical conditions of patients, influencing blood loss and consequently the number of transfusions. The secondary objective was to determine whether the influence of the orthogeriatrician differs according to the type of surgical treatment.

Methods

A total of 620 elderly patients treated for hip fracture were included in the study. These patients were divided into two groups according to the presence or not of the orthogeriatrician. For each patient, age, sex, comorbidities, type of fracture, surgical treatment, length of hospital stay, time from hospitalisation and surgery, time from surgery to discharge, haemoglobin (Hb) values (admission, 24h post-surgery, lowest Hb reached, discharge) and the number of transfusions were recorded.

Results

Regardless of the surgical procedure performed, in patients managed by the orthogeriatrician, the Hb at discharge was significantly higher (p = 0.003). In addition to the highest Hb at discharge, in patients who underwent hemiarthroplasty, the number of transfusions per patient is significantly reduced (p = 0.03).

Conclusion

The introduction of the orthogeriatrician in an orthopaedic ward for the management of elderly patients treated for hip fracture allows to discharge the patients with higher Hb values, reducing the risk of anemisation and the costs related to possible re-admission.

Koso RE, Sheets C, Richardson WJ, Galanos AN. Hip fracture in the elderly patients: a sentinel event. Am J Hosp Palliat Care. 2018;35(4):612–9. https://doi.org/10.1177/1049909117725057.CrossRefPubMed

Aletto C, Aicale R, Pezzuti G, Bruno F, Maffulli N. Impact of an orthogeriatrician on length of stay of elderly patient with hip fracture. Osteoporos Int. 2020;31(11):2161–6. https://doi.org/10.1007/s00198-020-05510-0.CrossRefPubMed

Ramponi DR, Kaufmann J, Drahnak G. Hip fractures. Adv Emerg Nurs J. 2018;40(1):8–15. https://doi.org/10.1097/TME.0000000000000180.CrossRefPubMed

de Miguel AM, Roca Chacón O, Martínez-Alonso M, et al. Hip fracture in the elderly patient: prognostic factors for mortality and functional recovery at one year. Rev Espanola Geriatr Gerontol. 2018;53:247–54.CrossRef

Magaziner J, Chiles N, Orwig D. Recovery after hip fracture: interventions and their timing to address deficits and desired outcomes--evidence from the Baltimore Hip Studies. Nestle Nutr Inst Workshop Ser. 2015;83:71–81. https://doi.org/10.1159/000382064.CrossRefPubMedPubMedCentral

Pareja Sierra T, Bartolomé Martín I, Rodríguez Solís J, et al. Predictive factors of hospital stay, mortality and functional recovery after surgery for hip fracture in elderly patients. Rev Espanola Cirugia Ortop Traumatol. 2017;61:427–35.

Glimcher MJ, Kenzora JE. The biology of osteonecrosis of the human femoral head and its clinical implications: II. The pathological changes in the femoral head as an organ and in the hip joint. Clin Orthop. 1979;139:283–312.

Koo K-H, Mont MA, Jones LC. Osteonecrosis. Berlin: Springer Berlin Heidelberg; 2014. https://doi.org/10.1007/978-3-642-35767-1.CrossRef

Yamamoto T, DiCarlo EF, Bullough PG. The prevalence and clinicopathological appearance of extension of osteonecrosis in the femoral head. J Bone Joint Surg Br. 1999;81:328–32.CrossRefPubMed

10.

Mehlhoff T, Landon GC, Tullos HS. Total hip arthroplasty following failed internal fixation of hip fractures. Clin Orthop. 1991;269:32–7.

11.

Pavelka T, Salášek M, Bárta P, Fridrich F, Džupa V. Avascular necrosis of femoral head and coxarthrosis progression after acetabular fractures. Acta Chir Orthop Traumatol Cech. 2019;86(6):381–9.PubMed

12.

Gautier E, Ganz K, Krügel N, Gill T, Ganz R. Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg Br. 2000;82(5):679–83. https://doi.org/10.1302/0301-620X.82B5.0820679.CrossRefPubMed

13.

Meunier A, Maczynski A, Asgassou S, Baulot E, Manckoundia P, Martz P. Mortality and functional independence one year after hip fracture surgery: extracapsular fracture versus intracapsular fracture. Geriatr Psychol Neuropsychiatr Vieil. 2019;17(2):153–62. https://doi.org/10.1684/pnv.2018.0769.CrossRefPubMed

14.

Butt FF, Hussain AS, Khan AM, Sultan M. Implants for extracapsular neck of femur fracture dynamic hip screw versus intramedullary nailing. J Ayub Med Coll Abbottabad. 2017;29(4):697–701.PubMed

15.

Hershkovitz A, Brill S, Sulam LN, Luria T, Heller S. Stability of extracapsular hip fracture: does it affect rehabilitation outcome of post-acute patients? Injury. 2018;49(7):1313–8. https://doi.org/10.1016/j.injury.2018.05.023.CrossRefPubMed

16.

Mattisson L, Bojan A, Enocson A. Epidemiology, treatment and mortality of trochanteric and subtrochanteric hip fractures: data from the Swedish fracture register. BMC Musculoskelet Disord. 2018;19(1):369. https://doi.org/10.1186/s12891-018-2276-3.CrossRefPubMedPubMedCentral

17.

Crilly RG, Kloseck M, Chesworth B, Mequanint S, Sadowski E, Gilliland J. Comparison of hip fracture and osteoporosis medication prescription rates across Canadian provinces. Osteoporos Int. 2014;25(1):205–10. https://doi.org/10.1007/s00198-013-2453-z.CrossRefPubMed

18.

Nogués X, Martinez-Laguna D. Update on osteoporosis treatment. Med Clin (Barc). 2018;150(12):479–86. https://doi.org/10.1016/j.medcli.2017.10.019.CrossRef

19.

Black DM, Geiger EJ, Eastell R, Vittinghoff E, Li BH, Ryan DS, et al. Atypical femur fracture risk versus fragility fracture prevention with bisphosphonates. N Engl J Med. 2020;383(8):743–53. https://doi.org/10.1056/NEJMoa1916525.CrossRefPubMed

20.

Vandenbroucke A, Luyten FP, Flamaing J, Gielen E. Pharmacological treatment of osteoporosis in the oldest old. Clin Interv Aging. 2017;12:1065–77. https://doi.org/10.2147/CIA.S131023.CrossRefPubMedPubMedCentral

21.

Balasubramanian A, Zhang J, Chen L, Wenkert D, Daigle SG, Grauer A, et al. Risk of subsequent fracture after prior fracture among older women. Osteoporos Int. 2019;30(1):79–92. https://doi.org/10.1007/s00198-018-4732-1.CrossRefPubMed

22.

Kanis JA, McCloskey EV, Johansson H, et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2013;24(1):23–57. https://doi.org/10.1007/s00198-012-2074-y.CrossRefPubMed

23.

Black DM, Rosen CJ. Clinical practice. Postmenopausal Osteoporosis. N Engl J Med. 2016;374(3):254–62. https://doi.org/10.1056/NEJMcp1513724.CrossRefPubMed

24.

von Friesendorff M, McGuigan FE, Wizert A, et al. Hip fracture, mortality risk, and cause of death over two decades. Osteoporos Int. 2016;27(10):2945–53. https://doi.org/10.1007/s00198-016-3616-5.CrossRef

25.

Guzon-Illescas O, Perez Fernandez E, Crespí Villarias N, Quirós Donate FJ, Peña M, Alonso-Blas C, et al. Mortality after osteoporotic hip fracture: incidence, trends, and associated factors. J Orthop Surg. 2019;14(1):203. https://doi.org/10.1186/s13018-019-1226-6.CrossRef

26.

Katsoulis M, Benetou V, Karapetyan T, Feskanich D, Grodstein F, Pettersson-Kymmer U, et al. Excess mortality after hip fracture in elderly persons from Europe and the USA: the CHANCES project. J Intern Med. 2017;281(3):300–10. https://doi.org/10.1111/joim.12586.CrossRefPubMed

27.

Mosk CA, Mus M, Vroemen JP, van der Ploeg T, Vos D, Elmans L, et al. Dementia and delirium, the outcomes in elderly hip fracture patients. Clin Interv Aging. 2017;12:421–30. https://doi.org/10.2147/CIA.S115945.CrossRefPubMedPubMedCentral

28.

Sim YE, Sim S-ED, Seng C, Howe TS, Koh SB, Abdullah HR. Preoperative anemia, functional outcomes, and quality of life after hip fracture surgery. J Am Geriatr Soc. 2018;66(8):1524–31. https://doi.org/10.1111/jgs.15428.CrossRefPubMed

29.

Pareja Sierra T, Bartolome Martín I, Rodríguez Solis J, Morales Sanz MD, Torralba Gonzalez de Suso M, Barcena Goitiandia LÁ, et al. Results of an anaemia treatment protocol complementary to blood transfusion in elderly patients with hip fracture. Rev Espanola Geriatr Gerontol. 2019;54(5):272–9. https://doi.org/10.1016/j.regg.2019.05.003.CrossRef

30.

Iliopoulos E, Yousaf S, Watters H, Khaleel A. Hospital stay and blood transfusion in elderly patients with hip fractures. J Perioper Pract. 2017;27(12):288–91. https://doi.org/10.1177/175045891702701203.CrossRefPubMed

31.

Hernlund E, Svedbom A, Ivergård M, et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos. 2013;8:136.CrossRefPubMedPubMedCentral

32.

Kelly M, Kates SL. Geriatric fracture centers-improved patient care and economic benefits : English Version. Unfallchirurg. 2017;120(S1):1–4. https://doi.org/10.1007/s00113-015-0092-x.CrossRefPubMed

33.

Roberts KC, Brox WT, Jevsevar DS, Sevarino K. Management of hip fractures in the elderly. J Am Acad Orthop Surg. 2015;23(2):131–7. https://doi.org/10.5435/JAAOS-D-14-00432.CrossRefPubMed

34.

Collin PG, D’Antoni AV, Loukas M, et al. Hip fractures in the elderly: a clinical anatomy review. Clin Anat. 2017;30(1):89–97. https://doi.org/10.1002/ca.22779.CrossRefPubMed

35.

Kanis JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group. Osteoporos Int. 1994;4(6):368–81. https://doi.org/10.1007/BF01622200.CrossRefPubMed

36.

Roche JJW, Wenn RT, Sahota O, Moran CG. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ. 2005;331(7529):1374. https://doi.org/10.1136/bmj.38643.663843.55.CrossRefPubMedPubMedCentral

37.

Wei J, Zeng L, Li S, Luo F, Xiang Z, Ding Q. Relationship between comorbidities and treatment decision-making in elderly hip fracture patients. Aging Clin Exp Res. 2019;31(12):1735–41. https://doi.org/10.1007/s40520-019-01134-5.CrossRefPubMedPubMedCentral

38.

Sim YE, Wee HE, Ang AL, Ranjakunalan N, Ong BC, Abdullah HR. Prevalence of preoperative anemia, abnormal mean corpuscular volume and red cell distribution width among surgical patients in Singapore, and their influence on one year mortality. PloS One. 2017;12(8):e0182543. https://doi.org/10.1371/journal.pone.0182543.CrossRefPubMedPubMedCentral

39.

Engoren M, Mitchell E, Perring P, Sferra J. The effect of erythrocyte blood transfusions on survival after surgery for hip fracture. J Trauma. 2008;65(6):1411–5. https://doi.org/10.1097/TA.0b013e318157d9f9.CrossRefPubMed

40.

Johnston P, Wynn-Jones H, Chakravarty D, Boyle A, Parker MJ. Is perioperative blood transfusion a risk factor for mortality or infection after hip fracture? J Orthop Trauma. 2006;20(10):675–9. https://doi.org/10.1097/01.bot.0000249435.25751.e8.CrossRefPubMed

41.

Carson JL, Duff A, Berlin JA, Lawrence VA, Poses RM, Huber EC, et al. Perioperative blood transfusion and postoperative mortality. JAMA. 1998;279(3):199–205. https://doi.org/10.1001/jama.279.3.199.CrossRefPubMed

42.

Blandfort S, Gregersen M, Borris LC, Damsgaard EM. Blood transfusion strategy and risk of postoperative delirium in nursing homes residents with hip fracture. A post hoc analysis based on the TRIFE randomized controlled trial. Aging Clin Exp Res. 2017;29(3):459–66. https://doi.org/10.1007/s40520-016-0587-5.CrossRefPubMed

43.

Potter LJ, Doleman B, Moppett IK. A systematic review of pre-operative anaemia and blood transfusion in patients with fractured hips. Anaesthesia. 2015;70(4):483–500. https://doi.org/10.1111/anae.12978.CrossRefPubMed

44.

Amin RM, DeMario VM, Best MJ, et al. A restrictive hemoglobin transfusion threshold of less than 7 g/dL decreases blood utilization without compromising outcomes in patients with hip fractures. J Am Acad Orthop Surg. 2019;27(23):887–94. https://doi.org/10.5435/JAAOS-D-18-00374.CrossRefPubMed

45.

Pioli G, Giusti A, Barone A. Orthogeriatric care for the elderly with hip fractures: where are we? Aging Clin Exp Res. 2008;20(2):113–22. https://doi.org/10.1007/BF03324757.CrossRefPubMed

46.

Friedman SM, Mendelson DA, Kates SL, McCann RM. Geriatric co-management of proximal femur fractures: total quality management and protocol-driven care result in better outcomes for a frail patient population. J Am Geriatr Soc. 2008;56(7):1349–56. https://doi.org/10.1111/j.1532-5415.2008.01770.x.CrossRefPubMed

47.

Halm EA, Wang JJ, Boockvar K, Penrod J, Silberzweig SB, Magaziner J, et al. Effects of blood transfusion on clinical and functional outcomes in patients with hip fracture. Transfusion. 2003;43(10):1358–65. https://doi.org/10.1046/j.1537-2995.2003.00527.x.CrossRefPubMed

Title: Haemoglobin and transfusions in elderly patients with hip fractures: the effect of a dedicated orthogeriatrician
Authors: Marco Quaranta
Luca Miranda
Francesco Oliva
Filippo Migliorini
Gabriela Pezzuti
Nicola Maffulli
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Hip-TEP
Hip-TEP
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2021
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-021-02524-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Haemoglobin and transfusions in elderly patients with hip fractures: the effect of a dedicated orthogeriatrician

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

The use of extracorporeal shock wave therapy for the treatment of bone marrow oedema — a systematic review and meta-analysis

Greater presence of receptors for relaxin in the ligamentum teres of female infants who undergo open reduction for developmental dysplasia of the hip

Fracture of the inferior pole of the patella: tension band wiring versus transosseous reattachment

Three-dimensional mapping of distal humerus fracture

Radiographic assessment of radiolucent lines around a highly porous titanium cup (Tritanium) using digital tomosynthesis, after total hip arthroplasty

Management of chronic knee pain caused by postsurgical or posttraumatic neuroma of the infrapatellar branch of the saphenous nerve