Background: Hip arthroplasty is a surgery with a high risk of bleeding. The main objective of this study was to research risk factors for bleeding and transfusion in patients undergoing hip hemiarthroplasty in Gabon. Method: It was a retrospective, monocentric, descriptive and analytical study carried out from June 2011 to June 2021 at the Omar Bongo Ondimba army training hospital. The variables studied were demographic characteristics, biological variables, transfusion and intraoperative data. The primary outcome was intraoperative transfusion. A univariate and multivariate analysis was conducted to identify the factors associated with the occurrence of a transfusion.Results: Of the 97 patients included, the average age was 74.2 years ± 10, male predominance was 73.2%, the average ASA score was 1.9 ± 0.5, and transfusion incidence was 38.1%. The average number of RBCs transfused was 1.2 ± 0.6. Tranexamic acid was used in 11.3% of patients. The average bleeding was 450 ± 453 ml. Preoperative anemia was predictor of transfusion to be significant. Conclusion: The incidence of transfusion is law compared to total hip arthroplasty. The implementation of a patient blood management protocol is difficult given the urgency of bone repair. However, a better use of tranexamic acid could reduce this transfusion incidence.
References
[1]
Li, X.B. and Luo, J.N. (2021) Hemiarthroplasty Compared to Total Hip Arthroplasty for the Treatment of Femoral Neck Fractures: A Systematic Review and Meta-Analysis. Journal of Orthopaedic Surgery and Research, 16, Article Number: 172. https://doi.org/10.1186/s13018-020-02186-4
[2]
Pangaud, C., Pioger, C., Pauly, V., Orleans, V., Boyer, L., Jean-Noël Argenson, D. and Matthieu Ollivier, D. (2023) Les prothèses totales de hanche permettent de réduire le risque de luxation après fracture du col fémoral. Revue de Chirurgie Orthopédique et Traumatologique, 109, 562-567. https://doi.org/10.1016/j.rcot.2023.02.002
[3]
Morgan, S., Jarvis, S., Conti, A., Staudinger, K., Reynolds, C. and Bar-Or, D. (2023) Displaced Geriatric Femoral Neck Fractures: A Retrospective Comparison of Total Hip Arthroplasties versus Hemiarthroplasty. Geriatric Orthopaedic Surgery & Rehabilitation, 14, 21514593231198949. https://doi.org/10.1177/21514593231198949
[4]
Nkilly, G.E., Ondo, R.O., Matsanga, A., Obiang, P.C.N., Oliveira, S., Nguiabanda, L., Mandji-Lawson, J.-M. and Tchoua, R. (2023) Frequency of Transfusions and Risk Factor for Bleeding Risk to Guide a Blood-Sparing Program during Hip Arthroplasty in Gabon. Open Journal of Anesthesiology, 13, 47-57. https://doi.org/10.4236/ojanes.2023.133005
[5]
Luangwaranyoo, A., Suksintharanon, M., Tangadulrat, P., Iamthanaporn, K., Hongnaparak, T. and Yuenyongviwat, V. (2020) Factors for Blood Transfusions Following Hemi Hip Arthroplasty for Patients with Femoral Neck Fracture. Geriatric Orthopaedic Surgery & Rehabilitation, 11, 2151459320972993. https://doi.org/10.1177/2151459320972993
[6]
Liodakis, E., Antoniou, J., Zukor, D.J., Huk, O.L., Epure, L.M. and Bergeron, S.G. (2016) Major Complications and Transfusion Rates after Hemiarthroplasty and Total Hip Arthroplasty for Femoral Neck Fractures. The Journal of Arthroplasty, 31, 2008-2012. https://doi.org/10.1016/j.arth.2016.02.019
[7]
Fowler, A.J., et al. (2015) Meta-Analysis of the Association between Preoperative Anaemia and Mortality after Surgery. British Journal of Surgery, 102, 1314-1324. https://doi.org/10.1002/bjs.9861
[8]
Jans, Ø., Jørgensen, C., Kehlet, H. and Johansson, P.I. (2014) Role of Preoperative Anemia for Risk of Transfusion and Postoperative Morbidity in Fast-Track Hip and Knee Arthroplasty. Transfusion, 54, 717-726. https://doi.org/10.1111/trf.12332
[9]
Noticewala, M.S., Nyce, J.D., Wang, W., Geller, J.A. and Macaulay, W. (2012) Predicting Need for Allogeneic Transfusion after Total Knee Arthroplasty. The Journal of Arthroplasty, 27, 961-967. https://doi.org/10.1016/j.arth.2011.10.008
[10]
Ogbemudia, A.E., Yee, S.Y., MacPherson, G.J., Manson, L.M. and Breusch, S.J. (2013) Preoperative Predictors for Allogenic Blood Transfusion in Hip and Knee Arthroplasty for Rheumatoid Arthritis. Archives of Orthopaedic and Trauma Surgery, 133, 1315-1320. https://doi.org/10.1007/s00402-013-1784-8
[11]
Sharma, V., Awasthi, B., Kumar, K., Kolhi, N. And Katoch, P. (2016) Outcome Analysis of Hemiarthroplasty vs. Total Hip Replacement in Displaced Femoral Neck Fractures in the Elderly. Journal of Clinical and Diagnostic Research, 10, 11-13. https://doi.org/10.7860/JCDR/2016/18638.7877
[12]
Blomfeldt, R., Törnkvist, H., Eriksson, K., Söderqvist, A., Ponzer, S. and Tidermark J. (2007) A Randomised Controlled Trial Comparing Bipolar Hemiarthroplasty with Total Hip Replacement for Displaced Intracapsular Fractures of the Femoral Neck in Elderly Patients. The Journal of Bone and Joint Surgery, 89, 160-165. https://doi.org/10.1302/0301-620X.89B2.18576
[13]
Sadigursky, D., Arujo, L.M. and Fernandes, R.J.C. (2018) Efficacity of Tranexamic Acid in Reducing Blood Loss in Total Knee Arthroplasty. Acta Ortopédica Brasileira, 26, 63-66. https://doi.org/10.1590/1413-785220182601149210
[14]
Gandhi, R., Evans, H.M.K., Mahomed, S.R. and Mahomed, N.N. (2013) Tranexamic Acid and the Reduction of Blood Loss in Total Knee and Hip Arthroplasty: A Meta-Analysis. BMC Research Notes, 6, Article Number: 184. https://doi.org/10.1186/1756-0500-6-184
[15]
Narkbunnam, R., Chompoonutprapa, A., Ruangsomboon, P., Udomkiat, P., Chareancholvanich, K. and Pornrattanamaneewong, C. (2021) Blood Loss and Transfusion Rate Compared among Different Dosing Regimens of Tranexamic Acid Administration in Patients Undergoing Hip Hemiarthroplasty for Femoral Neck Fracture: A Randomized Controlled Trial. Injury, 52, 2986-2990. https://doi.org/10.1016/j.injury.2021.08.001
[16]
Augustinus, S., Mulders, M.A.M., Gardenbroek, T.J. and Goslings, J.C. (2023) Tranexamic Acid in Hip Hemiarthroplasty Surgery: A Systematic Review and Meta-Analysis. European Journal of Trauma and Emergency Surgery, 49, 1247-1258. https://doi.org/10.1007/s00068-022-02180-x
[17]
Leverett, G.D. and Marriott, A. (2023) Intravenous Tranexamic Acid and Thrombo-embolic Events in Hip Fracture Surgery: A Systematic Review and Meta-Analysis. Orthopaedics & Traumatology: Surgery & Research, 109, Article ID: 103337. https://doi.org/10.1016/j.otsr.2022.103337
[18]
Maniar, R.N., et al. (2019) Role of Suction Drain after Knee Arthroplasty in the Tranexamic Acid Era: A Randomized Controlled Study. Clinics in Orthopedic Surgery, 11, 73-81. https://doi.org/10.4055/cios.2019.11.1.73
[19]
Sharma, G.M., Palekar, G. and Tanna, D.D. (2016) Use of Closed Suction Drain after Primary Total Knee Arthroplasty-an Overrated Practice. SICOT-J, 2, 39. https://doi.org/10.1051/sicotj/2016034