Delay of Surgery does not Increase Transfusion Rates in Extracapsular Proximal Femur Fractures Stabilized with Intramedullary Implants

Scope: Aim of the study was to determine whether the delay of surgery increased transfusion requirements in extracapsular proximal femur fractures stabilized with intramedullary implants. Materials and Methods: We performed an internal audit (retrospective analysis of prospectively collected data) on blood transfusion requirements for hip fractures. Into this study were included 151 consecutive extracapsular proximal femur fractures in patients older than 55 years operated in our clinic over 9 months. Results: About the 126 patients operated using a short intramedullary implant, the time from admission to surgery did not correlate with transfusion needs (p=0.650). Patient’s age was positively correlated with the number of the received transfusions (p=0.125). Patient’s hemoglobin at admission was inversely correlated (p<0.001), whereas the duration of surgery was positively correlated with the number of transfusions (p=0.091). For 25 patients operated using a long intramedullary implant, the preoperative hemoglobin was the only significant influence for transfusion (p=0.005). Patients operated in the day of admission needed fewer transfusions compared to patients with delayed intervention: differences not statistically significant (p=0.222). Patients with sub trochanteric fractures required significantly more red blood cell mass (1.1 ± 1.1 versus 1.6 ± 1.0 units, p=0.024) and fresh frozen plasma (0.5 ± 1.3 versus 1.2 ± 1.4 units, p=0.014) spending nearly twice as long to operate (64.0 ± 21.8 versus 123.4 ± 45.7 minutes, p<0.001). Conclusions: The postponement of surgery did not increase the need of allogenic blood. Nonetheless, the older patients with lower baseline hemoglobin at admission undergoing to longer surgeries, did not require more perioperative transfusions.