Navraj S. NAGRA, Dmitri van POPTA, Sigrid WHITESIDE, Edward M. HOL

An analysis of postoperative hemoglobin levels in patients with a fractured neck of femur

Objectives: The aim of this study was to analyze the changes in hemoglobin level and to determine asuitable timeline for post-operative hemoglobin monitoring in patients undergoingŞxation of femoralneck fracture.Patients and methods: Patients who underwent either dynamic hip screw (DHS)Şxation (n ¼ 74, meanage: 80 years) or hip hemiarthroplasty (n¼ 104, mean age: 84 years) for femoral neck fracture wereincluded into the study. The hemoglobin level of the patients was monitored perioperatively.Results: Analysis found a statistically and clinically signiŞcant mean drop in hemoglobin of 31.1 g/L overtime from pre-operatively (D0) to day-5 post-operatively (p< 0.001), with signiŞcant reductions from D0to day-1 and day-1 to day-2 (p< 0.001). At each post-operative time point, DHS patients had lowerhemoglobin values over hemiarthroplasty patients (p¼ 0.046).Conclusion: The decrease in hemoglobin in theŞrst 24-h post-operative period (D0 to day-1) is anunderestimation of the ultimate lowest value in hemoglobin found at day-2. Relying on the day-1 hemoglobin could be detrimental to patient care. We propose a method of predicting patients likely to betransfused, and recommend a protocol for patients undergoing femoral neck fracture surgery to standardize postoperative hemoglobin monitoring.Level of evidence: Level IV Prognostic study.© 2016 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V. This isan open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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