ORIGINAL ARTICLES   

Minerva Ortopedica e Traumatologica 2012 August;63(4):263-70

Copyright © 2012 EDIZIONI MINERVA MEDICA

language: Italian

Blood management in patients affected by proximal femoral fracture: risk factors evaluation and suggestion of a protocol for rationalization of homologous blood use

Fissore L. ¹, Tellini A. ², Gastaldo C. ¹, Pellegrino P. ¹, Sito G. ¹, Rossi P. ², Blonna D. ³

¹ Università degli Studi di Torino; ² Dipartimento di Ortopedia e Traumatologia, CTO, Torino, Italia; ³ Dipartimento di Ortopedia e Traumatologia, Ospedale Mauriziano, Torino, Italia

Aim. Aim of the study was transfusion’s risks evaluation and protocol suggestion for the rationalization of the homologous blood transfusion in patients affected by proximal femur fracture.
Methods. We examined 209 patients during the 2009 with a diagnosis of proximal epiphysis fracture undergoing synthesis or prothesis implant surgery. For all the kind of surgery used, we tested the principal risk factors for the blood transfusion and the blood bags waste.
Results. The risk of wasting blood bags is bigger in the surgery day. Using the Gamma Nail is a protective factor towards the necessity of transfusion (P=0.0082), meanwhile using a proximal hip prothesis, a bone fixation plates or a long Gamma Nail are risk factors for blood transfusion (P=0.0097). Presurgery hemoglobin value <11 g/dL is a risk factor for both Gamma Nail and proximal hip prothesis.
Conclusion. Our protocol’s suggestion for a better use of the homologous blood in the perioperative time, based on our data, advises: 1) presurgery determination of type and screen (TS) for the bone fixation plates osteosynthesis; 2) presurgery TS determination with Gamma Nail and proximal hip prothesis if Hb is >11 g/dL; 3) one blood bag for Gamma Nail and proximal hip prothesis if Hb is <11 g/dL; 4) two blood bags with other kinds of surgery.