title: Preoperative moderate renal impairment is an independent risk factor of transfusion in elderly patients undergoing hip fracture surgery and receiving low-molecular-weight heparin for thromboprophylaxis.
abstract: OBJECTIVE
  To define the risk factors of allogeneic erythrocyte transfusion in patients older than 65 years of age who underwent hip fracture surgery.
  
  
  METHODS
  Retrospective, single-center study.
  
  
  METHODS
  Orthopedic unit of a university hospital.
  
  
  METHODS
  The records of 413 consecutive patients undergoing hip fracture surgery over a 12-month period and receiving low-molecular-weight heparin (LMWH) for thromboprophylaxis were retrospectively reviewed. Preoperative independent predictors of transfusion were determined by multivariate analysis, from which a model of individual probability of transfusion was derived using creatinine clearance calculated by Cockroft-Gault (CG) and the Modification of Diet in Renal Disease (MDRD) formulas.
  
  
  RESULTS
  Using the CG and MDRD formulas, 56.9% and 50.1% of patients had moderate renal impairment that was an independent factor associated with transfusion, with adjusted odds ratios of 2.44 (1.49 - 4.02) and 2.35 (1.32 - 4.18), respectively. Other factors were fracture with trochanteric extension, preoperative hemoglobin (Hb) < 12 g/dL, and weight. The observed transfusion rate and probability of transfusion calculated with the regression logistic model were well correlated: y = 0.9534x + 0.0287, P < 0.0001, Pearson coefficient 0.988, goodness of fit, χ(2), P = 1 with CG; y = 0.9197x + 0.0504, P < 0.0001, Pearson coefficient 0.956, goodness of fit, χ(2), P = 1 with MDRD).
  
  
  CONCLUSIONS
  This predictive model may be useful to identify those elderly patients undergoing hip fracture repair who are at risk of blood transfusion.
authors.affiliation: CHU Nantes, Service d'Anesthésie et de Réanimation Chirurgicale, Hôtel-Dieu Hôpital Mère Enfant, Place Alexis Ricordeau, F- 44000 Nantes, France. corinne.lejus@chu-nantes.fr
authors.forename: Corinne
authors.initials: C
authors.lastname: Lejus
authors.forename: Aurore
authors.initials: A
authors.lastname: Desdoits
authors.forename: Chantal
authors.initials: C
authors.lastname: Lambert
authors.forename: Cécile
authors.initials: C
authors.lastname: Langlois
authors.forename: Antoine
authors.initials: A
authors.lastname: Roquilly
authors.forename: François
authors.initials: F
authors.lastname: Gouin
authors.forename: Karim
authors.initials: K
authors.lastname: Asehnoune
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D016063:Blood Loss, Surgical; D003404:Creatinine / Q000097:blood; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects*; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D057234:Preoperative Period; D051437:Renal Insufficiency / Q000150:complications* / Q000175:diagnosis; D012189:Retrospective Studies; D012307:Risk Factors; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D006454:Hemoglobins; D006495:Heparin, Low-Molecular-Weight; D003404:Creatinine