title: An analysis of postoperative hemoglobin levels in patients with a fractured neck of femur.
abstract: OBJECTIVE
  The aim of this study was to analyze the changes in hemoglobin level and to determine a suitable timeline for post-operative hemoglobin monitoring in patients undergoing fixation of femoral neck fracture.
  
  
  METHODS
  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 were included into the study. The hemoglobin level of the patients was monitored perioperatively.
  
  
  RESULTS
  Analysis found a statistically and clinically significant mean drop in hemoglobin of 31.1 g/L over time from pre-operatively (D0) to day-5 post-operatively (p < 0.001), with significant reductions from D0 to day-1 and day-1 to day-2 (p < 0.001). At each post-operative time point, DHS patients had lower hemoglobin values over hemiarthroplasty patients (p = 0.046).
  
  
  CONCLUSIONS
  The decrease in hemoglobin in the first 24-h post-operative 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 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.
  
  
  METHODS
  Level IV Prognostic study.
authors.affiliation: University of Oxford, Oxford, UK. Electronic address: navraj.nagra@ox.ac.uk.
authors.forename: Navraj S
authors.initials: NS
authors.lastname: Nagra
authors.affiliation: University Hospital of South Manchester, NHS Foundation Trust, Wythenshawe M23 9LT, UK.
authors.forename: Dmitri
authors.initials: D
authors.lastname: van Popta
authors.affiliation: University Hospital of South Manchester, NHS Foundation Trust, Wythenshawe M23 9LT, UK.
authors.forename: Sigrid
authors.initials: S
authors.lastname: Whiteside
authors.affiliation: University Hospital of South Manchester, NHS Foundation Trust, Wythenshawe M23 9LT, UK.
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*; D005269:Femur / 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; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D006454:Hemoglobins
keywords: Fracture; Hemoglobin; Neck of femur; Postoperative