Foss and Kehlet identified risk factors associated with occult blood loss following surgery to correct a hip fracture. These can help identify patients who may require blood transfusion following surgery. The authors are from Copenhagen, Denmark.


Blood loss following surgical repair of a hip fracture can be up to 6 times that recorded during the surgery. Medical complications (but not mortality) were increased if there was significant blood loss. An older patient with serious comorbid conditions may be at greater risk for complications if there is significant and prolonged anemia.


Risk factors for occult blood loss after surgery:

(1) type of surgery performed

(2) preoperative therapy with aspirin

(3) intra-operative hypotension (mean arterial blood pressure < 60 mm Hg)

(4) gastrointestinal bleeding (associated with peptic ulceration or other source)


The use of an intramedullary hip nail and screw (used for (a) transtrochanteric, (b) subtrochanteric and (c) trochanteric fractures with a subtrochanteric component) had almost 3 time the blood loss seen with screws and pins.


Confounding factors:

(1) dehydration prior to surgery

(2) overhydration during resuscitation and surgery

(3) anticoagulation (bleeding would probably not be occult)

(4) blood loss associated with other traumatic injuries


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