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A prospective study about the preoperative total blood loss in older people with hip fracture

Authors Wu JZ, Liu PC, Ge W, Cai M

Received 24 August 2016

Accepted for publication 7 October 2016

Published 31 October 2016 Volume 2016:11 Pages 1539—1543

DOI https://doi.org/10.2147/CIA.S120526

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Professor Zhi-Ying Wu

Jie-Zhou Wu,1,2,* Peng-Cheng Liu,1,* Wei Ge,1,2 Ming Cai1

1Department of Orthopedics, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 2The First Clinical Medical College, Nanjing Medical University, Nanjing, People’s Republic of China

*These authors contributed equally to this work

Purpose: Our study is to confirm that hemoglobin (Hb) level is significantly reduced before operation in elderly patients with hip fracture and to specify potential amounts of bleeding and Hb decline in different types of fractures. 
Methods: A prospective analysis was made on the clinical data of 349 patients with both a diagnosis of hip fracture and an operative delay of greater than 72 hours between April 2014 and February 2016. Hb concentration was measured on a daily basis before the surgery. Patients were grouped according to the type of fracture (intracapsular and extracapsular) for calculation of the total blood loss (TBL). All data analyses were done by SPSS version 21 software. 
Results: There was a significant decrease preoperatively in the Hb concentration of nearly 21.55 g/L (standard error of the mean [SEM] 7.67) in patients with extracapsular hip fractures and nearly 15.63 g/L (SEM 6.01) in patients with intracapsular hip fractures. The preoperative TBL in patients with extracapsular fracture was significantly larger compared to that in patients with intracapsular fracture (790.3 mL and 581.7 mL, respectively, P<0.05 using Student’s t-test). We found no significant difference in the preoperative TBL between the male and female groups. 
Conclusion: Hip fracture patients have an obvious blood loss after the injury, yet prior to the surgery the Hb levels were found to be normal. Anesthetic and orthopedic staff should pay additional attention to the problem of low preoperative Hb concentration, even if the initial Hb level was apparently normal.

Keywords: hip fracture, blood loss, anemia, preoperation, hemoglobin

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