title: Postoperative hemoglobin level in patients with femoral neck fracture.
abstract: OBJECTIVE
  The aim of this study was to analyze the changes of hemoglobin levels in patients undergoing fixation for femoral neck fracture.
  
  
  METHODS
  Peroperative hemoglobin levels of patients who underwent either dynamic hip screw (DHS) fixation (n=74; mean age: 80 years) or hip hemiarthroplasty (n=104; mean age: 84 years) for femoral neck fracture was monitored.
  
  
  RESULTS
  There was a statistically and clinically significant mean drop of 31.1 g/L between the preoperative (D0) and postoperative Day 5 Hb levels (p<0.001), with significant reductions from D0 to Day 1 and Day 1 to Day 2 (p<0.001). At each postoperative measurement, DHS patients had lower hemoglobin values over hemiarthroplasty patients (p=0.046).
  
  
  CONCLUSIONS
  The decrease in hemoglobin in the first 24-hour postoperative period (D0 to Day 1) is an underestimation of the ultimate lowest value in hemoglobin found at Day 2. Relying on the Day 1 hemoglobin level could be detrimental to patient care. We propose a method of predicting patients likely to be transfused and recommend a protocol for patients undergoing femoral neck fracture surgery to standardize postoperative hemoglobin monitoring.
authors.affiliation: Oxford University Clinical Academic Graduate School, John Radcliffe Hospital, Department of Orthopaedic Surgery, Oxford, United Kingdom. navraj.nagra@msd.ox.ac.uk.
authors.forename: Navraj S
authors.initials: NS
authors.lastname: Nagra
authors.affiliation: University Hospital of South Manchester NHS Foundation Trust, Department of Orthopaedic Surgery, Wythenshawe, United Kingdom.
authors.forename: Dmitri
authors.initials: D
authors.lastname: Van Popta
authors.affiliation: University Hospital of South Manchester NHS Foundation Trust, Department of Orthopaedic Surgery, Wythenshawe, United Kingdom.
authors.forename: Sigrid
authors.initials: S
authors.lastname: Whiteside
authors.affiliation: University Hospital of South Manchester NHS Foundation Trust, Department of Orthopaedic Surgery, Wythenshawe, United Kingdom.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Holt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods*; D062785:Hemiarthroplasty / Q000379:methods*; D006454:Hemoglobins / Q000737:chemistry*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D013997:Time Factors; D006113:United Kingdom
chemical_list: D006454:Hemoglobins