Analysis of perioperative blood loss by fast track protocol in cephalomedullary nailing for geriatric intertrochanteric fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Wentao ,  WANG Baojun , BAI Xiaodong , GAO Hua , LIU Zhenyu , LI Yadong , ZHAO Liang

Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, P.R.China;

Corresponding?author：

WANG Baojun, Email: docbjwang@126.com

Keywords：

Intertrochanteric fracture; fast track; hidden blood loss; operative waiting time; hematocrit

DOI：

10.7507/1002-1892.201904143

Video：

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Objective To analyze the effectiveness of fast track protocol of geriatric intertrochanteric fracture on operative waiting time, operation time, perioperative blood loss, providing data support for clinical therapy.Methods The clinical data of 240 elderly patients with intertrochanteric fracture admitted between January 2015 and December 2018 were retrospectively analyzed. They were divided into traditional protocol group (148 cases, group A) and fast track group (92 cases, group B). All patients were treated with closed reduction intramedullary nail (proximal femoral nail antirotation) surgery. There was no significant difference in gender, age, sides, fracture classification, fracture type, complications, the proportion of patients with more than 3 kinds of medical diseases, and the time from injury to admission between the two groups (P>0.05). Analysis index included operative waiting time (hospitalization to operation time), operation time, percentage of operation performing in 48 and 72 hours, percentage of transfusion, changes of hematocrit (Hct) at different stage (admission, operation day, and postoperative 1, 3 days), blood loss by fracture and cephalomedullary nail, intraoperative dominant blood loss, total blood loss in perioperative period were recorded and compared.Results The operative waiting time, operation time, Hct on operation day and postoperative 3 days, blood loss by fracture, transfusion volume, and total blood loss in perioperative period in group B were significantly less than those in group A (P<0.05), and the percentage of operation performing in 48 and 72 hours in group B were significantly higher than those in group A (P<0.05). There was no signifcant difference in Hct on admission and postoperative 1 day, intraoperative dominant blood loss, percentage of transfusion, blood loss by cephalomedullary nail between the two groups (P>0.05).Conclusion Fast track can shorten the operative waiting time of geriatric intertrochanteric fracture, reduce the blood loss by fracture, total blood loss in perioperative period, and transfusion volume. Early operation is conducive to improve the anemia status of patients during perioperative period.

Citation： CHEN Wentao, WANG Baojun, BAI Xiaodong, GAO Hua, LIU Zhenyu, LI Yadong, ZHAO Liang. Analysis of perioperative blood loss by fast track protocol in cephalomedullary nailing for geriatric intertrochanteric fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(10): 1265-1269. doi: 10.7507/1002-1892.201904143 Copy

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2.	Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology, 1983, 58(3): 277-280.
3.	Bhandari M, Swiontkowski M. Management of acute hip fracture. N Engl J Med, 2017, 377(21): 2053-2062.
4.	Li S, Sun T, Liu Z. Excess mortality of 1 year in elderly hip fracture patients compared with the general population in Beijing, China. Arch Osteoporos, 2016, 11(1): 35.
5.	Uzoigwe CE, Burnand HG, Cheesman CL, et al. Early and ultra-early surgery in hip fracture patients improves survival. Injury, 2013, 44(6): 726-729.
6.	Rosso F, Dettoni F, Bonasia DE, et al. Prognostic factors for mortality after hip fracture: Operation within 48 hours is mandatory. Injury, 2016, 47 Suppl 4: S91-S97.
7.	Larsson G, Holgers KM. Fast-track care for patients with suspected hip fracture. Injury, 2011, 42(11): 1257-1261.
8.	Larsson G, Str?mberg RU, Rogmark C, et al. Prehospital fast track care for patients with hip fracture: Impact on time to surgery, hospital stay, post-operative complications and mortality a randomised, controlled trial. Injury, 2016, 47(4): 881-886.
9.	丁濤, 張保焜, 田少奇, 等. 老年髖部骨折手術方法的選擇原則及應用現狀. 中國修復重建外科雜志, 2018, 32(11): 1435-1440.
10.	張世民, 李海豐, 俞光榮. 老年髖部骨折的臨床治療流程. 中國矯形外科雜志, 2005, 13(18): 1365-1368.
11.	張英澤. 成人髖部骨折指南解讀. 中華外科雜志, 2015, 53(1): 57-62.
12.	黃立新, 郭炯炯. 2011 英國國家健康與臨床優化研究所成人髖部骨折指南解讀及股骨轉子間骨折的治療概念演變. 中國醫學前沿雜志(電子版), 2012, 4(11): 66-69.
13.	張長青, 張偉. 我國老年髖部骨折綠色通道建設的現實意義. 中華創傷雜志, 2014, 30(3): 196-198.
14.	李寧, 賀良, 龔曉峰, 等. 老年髖部骨折住院患者治療現狀的初步分析. 中華醫學雜志, 2012, 92(35): 2452-2455.
15.	Smith GH, Tsang J, Molyneux SG, et al. The hidden blood loss after hip fracture. Injury, 2011, 42(2): 133-135.
16.	祝曉忠, 張世民, 王欣, 等. 老年股骨轉子間骨折 PFNA 內固定的隱性失血. 中國矯形外科雜志, 2010, 18(17): 1423-1426.
17.	李明東, 胡稷杰, 黎早敏, 等. 不同手術方式治療老年股骨粗隆間骨折的療效比較. 中國修復重建外科雜志, 2017, 31(6): 653-658.
18.	張培訓, 薛峰, 安帥, 等. 股骨近端防旋髓內釘和動力髖螺釘治療股骨粗隆間骨折的顯性和隱性失血量分析. 北京大學學報 (醫學版), 2012, 44(6): 891-894.
19.	王益民, 董啟榕, 韋兆祥, 等. 高齡股骨轉子間骨折患者圍手術期隱性失血的原因分析. 中華醫學雜志, 2014, 94(1): 67-68.
20.	Friedman SM, Mendelson DA, Kates SL, et al. 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): 1349-1356.
21.	張長青, 張偉. 對老年髖部骨折救治綠色通道建設的思考與展望. 中華創傷骨科雜志, 2015, 17(2): 95-96.
22.	楊明輝, 吳新寶, 龔曉峰, 等. 骨科與老年科共管模式治療老年髖部骨折及與英國的比較. 中國骨與關節雜志, 2017, 6(3): 169-173.

1. 張瑞鵬, 尹英超, 李石倫, 等. 髖部骨折指南解讀與診療現狀分析. 河北醫科大學學報, 2018, 39(6): 621-622, 627.
2. Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology, 1983, 58(3): 277-280.
3. Bhandari M, Swiontkowski M. Management of acute hip fracture. N Engl J Med, 2017, 377(21): 2053-2062.
4. Li S, Sun T, Liu Z. Excess mortality of 1 year in elderly hip fracture patients compared with the general population in Beijing, China. Arch Osteoporos, 2016, 11(1): 35.
5. Uzoigwe CE, Burnand HG, Cheesman CL, et al. Early and ultra-early surgery in hip fracture patients improves survival. Injury, 2013, 44(6): 726-729.
6. Rosso F, Dettoni F, Bonasia DE, et al. Prognostic factors for mortality after hip fracture: Operation within 48 hours is mandatory. Injury, 2016, 47 Suppl 4: S91-S97.
7. Larsson G, Holgers KM. Fast-track care for patients with suspected hip fracture. Injury, 2011, 42(11): 1257-1261.
8. Larsson G, Str?mberg RU, Rogmark C, et al. Prehospital fast track care for patients with hip fracture: Impact on time to surgery, hospital stay, post-operative complications and mortality a randomised, controlled trial. Injury, 2016, 47(4): 881-886.
9. 丁濤, 張保焜, 田少奇, 等. 老年髖部骨折手術方法的選擇原則及應用現狀. 中國修復重建外科雜志, 2018, 32(11): 1435-1440.
10. 張世民, 李海豐, 俞光榮. 老年髖部骨折的臨床治療流程. 中國矯形外科雜志, 2005, 13(18): 1365-1368.
11. 張英澤. 成人髖部骨折指南解讀. 中華外科雜志, 2015, 53(1): 57-62.
12. 黃立新, 郭炯炯. 2011 英國國家健康與臨床優化研究所成人髖部骨折指南解讀及股骨轉子間骨折的治療概念演變. 中國醫學前沿雜志(電子版), 2012, 4(11): 66-69.
13. 張長青, 張偉. 我國老年髖部骨折綠色通道建設的現實意義. 中華創傷雜志, 2014, 30(3): 196-198.
14. 李寧, 賀良, 龔曉峰, 等. 老年髖部骨折住院患者治療現狀的初步分析. 中華醫學雜志, 2012, 92(35): 2452-2455.
15. Smith GH, Tsang J, Molyneux SG, et al. The hidden blood loss after hip fracture. Injury, 2011, 42(2): 133-135.
16. 祝曉忠, 張世民, 王欣, 等. 老年股骨轉子間骨折 PFNA 內固定的隱性失血. 中國矯形外科雜志, 2010, 18(17): 1423-1426.
17. 李明東, 胡稷杰, 黎早敏, 等. 不同手術方式治療老年股骨粗隆間骨折的療效比較. 中國修復重建外科雜志, 2017, 31(6): 653-658.
18. 張培訓, 薛峰, 安帥, 等. 股骨近端防旋髓內釘和動力髖螺釘治療股骨粗隆間骨折的顯性和隱性失血量分析. 北京大學學報 (醫學版), 2012, 44(6): 891-894.
19. 王益民, 董啟榕, 韋兆祥, 等. 高齡股骨轉子間骨折患者圍手術期隱性失血的原因分析. 中華醫學雜志, 2014, 94(1): 67-68.
20. Friedman SM, Mendelson DA, Kates SL, et al. 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): 1349-1356.
21. 張長青, 張偉. 對老年髖部骨折救治綠色通道建設的思考與展望. 中華創傷骨科雜志, 2015, 17(2): 95-96.
22. 楊明輝, 吳新寶, 龔曉峰, 等. 骨科與老年科共管模式治療老年髖部骨折及與英國的比較. 中國骨與關節雜志, 2017, 6(3): 169-173.

Chinese Journal of Reparative and Reconstructive Surgery

Analysis of perioperative blood loss by fast track protocol in cephalomedullary nailing for geriatric intertrochanteric fractures

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