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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10.	张世民, 李海丰, 俞光荣. 老年髋部骨折的临床治疗流程. 中国矫形外科杂志, 2005, 13(18): 1365-1368.
11.	张英泽. 成人髋部骨折指南解读. 中华外科杂志, 2015, 53(1): 57-62.
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13.	张长青, 张伟. 我国老年髋部骨折绿色通道建设的现实意义. 中华创伤杂志, 2014, 30(3): 196-198.
14.	李宁, 贺良, 龚晓峰, 等. 老年髋部骨折住院患者治疗现状的初步分析. 中华医学杂志, 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.
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17.	李明东, 胡稷杰, 黎早敏, 等. 不同手术方式治疗老年股骨粗隆间骨折的疗效比较. 中国修复重建外科杂志, 2017, 31(6): 653-658.
18.	张培训, 薛峰, 安帅, 等. 股骨近端防旋髓内钉和动力髋螺钉治疗股骨粗隆间骨折的显性和隐性失血量分析. 北京大学学报 (医学版), 2012, 44(6): 891-894.
19.	王益民, 董启榕, 韦兆祥, 等. 高龄股骨转子间骨折患者围手术期隐性失血的原因分析. 中华医学杂志, 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.	张长青, 张伟. 对老年髋部骨折救治绿色通道建设的思考与展望. 中华创伤骨科杂志, 2015, 17(2): 95-96.
22.	杨明辉, 吴新宝, 龚晓峰, 等. 骨科与老年科共管模式治疗老年髋部骨折及与英国的比较. 中国骨与关节杂志, 2017, 6(3): 169-173.

1. 张瑞鹏, 尹英超, 李石伦, 等. 髋部骨折指南解读与诊疗现状分析. 河北医科大学学报, 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, Strömberg 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. 丁涛, 张保焜, 田少奇, 等. 老年髋部骨折手术方法的选择原则及应用现状. 中国修复重建外科杂志, 2018, 32(11): 1435-1440.
10. 张世民, 李海丰, 俞光荣. 老年髋部骨折的临床治疗流程. 中国矫形外科杂志, 2005, 13(18): 1365-1368.
11. 张英泽. 成人髋部骨折指南解读. 中华外科杂志, 2015, 53(1): 57-62.
12. 黄立新, 郭炯炯. 2011 英国国家健康与临床优化研究所成人髋部骨折指南解读及股骨转子间骨折的治疗概念演变. 中国医学前沿杂志(电子版), 2012, 4(11): 66-69.
13. 张长青, 张伟. 我国老年髋部骨折绿色通道建设的现实意义. 中华创伤杂志, 2014, 30(3): 196-198.
14. 李宁, 贺良, 龚晓峰, 等. 老年髋部骨折住院患者治疗现状的初步分析. 中华医学杂志, 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. 祝晓忠, 张世民, 王欣, 等. 老年股骨转子间骨折 PFNA 内固定的隐性失血. 中国矫形外科杂志, 2010, 18(17): 1423-1426.
17. 李明东, 胡稷杰, 黎早敏, 等. 不同手术方式治疗老年股骨粗隆间骨折的疗效比较. 中国修复重建外科杂志, 2017, 31(6): 653-658.
18. 张培训, 薛峰, 安帅, 等. 股骨近端防旋髓内钉和动力髋螺钉治疗股骨粗隆间骨折的显性和隐性失血量分析. 北京大学学报 (医学版), 2012, 44(6): 891-894.
19. 王益民, 董启榕, 韦兆祥, 等. 高龄股骨转子间骨折患者围手术期隐性失血的原因分析. 中华医学杂志, 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. 张长青, 张伟. 对老年髋部骨折救治绿色通道建设的思考与展望. 中华创伤骨科杂志, 2015, 17(2): 95-96.
22. 杨明辉, 吴新宝, 龚晓峰, 等. 骨科与老年科共管模式治疗老年髋部骨折及与英国的比较. 中国骨与关节杂志, 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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