title: Predicting the need for blood transfusions in elderly patients with pertrochanteric femoral fractures.
abstract: OBJECTIVE
  The need exists for perioperative blood management measures aimed at improving patient outcomes and reducing the risks of allogeneic blood transfusion (ABT). Our study aim is to discuss an algorithm to predict the need for perioperative blood transfusion in old patients with pertrochanteric femoral fractures.
  
  
  METHODS
  We retrospectively analysed the data from 220 elderly patients with pertrochanteric femoral fractures with regard to the probability of receiving an ABT within 72h after surgery. The patients were divided into ABT and non-ABT groups. A univariate analysis was used to compare between-group differences with regard to 13 variables. A logistic regression analysis and a probability algorithm to predict the need for an ABT based on independent predictors were used.
  
  
  RESULTS
  The non-ABT group included 131 patients (55 males and 76 females), with an average age of 77.2±6.8 years; the ABT group included 89 patients (29 males and 60 females), with an average age of 79.7±6.6 years. The total volume of transfused blood was 276 Units; the actual average blood transfusion was 3.1±1.47 Units. Significant between-group differences (P<0.05) were observed with regard to age, duration of operation, haemoglobin (Hb) at admission, intra-operative blood loss, type of fracture and type of anaesthesia. The mean volume of transfused blood in the proximal femoral nail anti-rotation (PFNA) and Gamma3 group was larger than that of the dynamic hip screw (DHS) group (P<0.05). A logistic regression analysis revealed that patients with pertrochanteric femoral fractures who were elderly (>81 years), had lower Hb levels at admission (≤124g/L), longer duration of operations (t>85min), underwent intramedullary fixation (Gamma3 and PFNA) and had more intra-operative blood loss were more likely to need an ABT. This regression model predicted 74.1% of the transfused cases.
  
  
  CONCLUSIONS
  An algorithm was devised to predict and manage the need for an ABT within 72h after surgery in patients with pertrochanteric femoral fractures. A reasonable transfusion program might reduce the complications caused by anaemia and effectively avoid the risks associated with ABTs.
authors.affiliation: Department of Orthopaedic Surgery, Peking University Third Hospital, No 49, North Garden Rd, HaiDian District, Beijing 100191, China. Electronic address: pkuhgj@163.com.
authors.forename: Guojin
authors.initials: G
authors.lastname: Hou
authors.affiliation: Department of Orthopaedic Surgery, Peking University Third Hospital, No 49, North Garden Rd, HaiDian District, Beijing 100191, China. Electronic address: zhouf@bjmu.edu.cn.
authors.forename: Fang
authors.initials: F
authors.lastname: Zhou
authors.affiliation: Department of Orthopaedic Surgery, Peking University Third Hospital, No 49, North Garden Rd, HaiDian District, Beijing 100191, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Tian
authors.affiliation: Department of Orthopaedic Surgery, Peking University Third Hospital, No 49, North Garden Rd, HaiDian District, Beijing 100191, China.
authors.forename: Hongquan
authors.initials: H
authors.lastname: Ji
authors.affiliation: Department of Orthopaedic Surgery, Peking University Third Hospital, No 49, North Garden Rd, HaiDian District, Beijing 100191, China.
authors.forename: Zhishan
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Orthopaedic Surgery, Peking University Third Hospital, No 49, North Garden Rd, HaiDian District, Beijing 100191, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Guo
authors.affiliation: Department of Orthopaedic Surgery, Peking University Third Hospital, No 49, North Garden Rd, HaiDian District, Beijing 100191, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Lv
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods*; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D019990:Perioperative Care; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors
keywords: Allogeneic; Blood transfusion; Hip fractures; Internal fixation; Perioperative period; Pertrochanteric fractures; Surgery; The elderly