Excessive blood loss was defined as a volume > 480 mL.
Risk factors identified on multivariate analysis:
(1) hemiarthroplasty used to correct the fracture
(2) patients at risk for cardiac or cerebral ischemia following volume depletion (see 05.13.07: history of TIA, history of thrombotic stroke, coronary artery disease, congestive heart failure, aortic stenosis or other hemodynamically significant valvular heart disease)
Additional risk factors seen on the univariate analysis:
(1) ASA class III or IV
(2) >= 2 pre-existing comorbid conditions
Hemiarthroplasty has a number of interesting connotations:
(1) The alternative operative repair is placement of screws, which is simpler.
(2) A hemiarthroplasty involves more extensive bone preparation with risk for blood loss.
(3) Hemiarthroplasty is done when screws are unlikely to work well. According to Swionkowski, the following are indications for hemiarthroplasty:
(3a) pathologic bone
(3b) rheumatoid arthritis, chronic renal failure or other serious comorbid disease associated with poor fracture healing
(3c) limited lifespan (advanced physiologic age)
One factor not discussed is the coagulation status of the patients. People identified as being at risk for excessive blood loss are also patients who may be on anticoagulation prior to and after surgery.
