Influencing factors for perioperative allogeneic red blood cell transfusion in elderly patients with hip fractures
Objective By analyzing the relevant factors affecting perioperative allogeneic red blood cell(RBC)transfusion in elderly hip fracture patients,aiming to develop targeted intervention measures to reduce the rate of perioperative allogeneic RBC transfusion rate and ensure the safety of blood transfusion.Methods A total of 200 eligible elderly patients with hip fractures admitted in our orthopedic department from August 2021 to August 2022 were selected as the study objects.They were divided into blood transfusion group(n=96)and non-blood transfusion group(n=104)according to the application of allogeneic RBC transfusion.The perioperative clinical data of patients before,during and after surgery were collected.Postoperative complications and perioperative data were compared for analyzing independent risk factors for allogeneic RBC transfusion.Results Among 200 elderly patients with hip fractures,96 patients received perioperative allogeneic RBC transfusion,while 104 patients did not receive it.The rate of perioperative allogeneic RBC transfusion was 48.00%(96/200).The overall incidence of postoperative complications like infections,cardiovascular diseases,stress ulcer and thrombosis in the blood transfusion group was significantly higher than that of the non-blood transfusion group(χ2=4.309,P<0.05).There were significant differences in the sex,age,body mass index(BMI),type of fractures,use of antiplatelet aggregation drugs,hemoglobin(Hb),hematocrit(HCT),albumin(ALB),creatine(Cr)and the American Society of Anesthesiologists physical status classification(ASA)on admission,type of anesthesia,type of surgery,surgical time,intraoperative bleeding,postoperative intubation of drainage tube,postoperative Hb and transfusion volume of allogeneic RBC between groups(P<0.05).Multivariate logistic regression analysis showed that advanced age,low BMI,intertrochanteric fractures,low Hb,low HCT,low ALB,high Cr and grade III ASA physical status classification and above on admission,general anesthesia,long surgical time,great intraoperative bleeding and postoperative intubation of drainage tube were independent risk factors for perioperative allogeneic RBC transfusion in elderly patients with hip fractures(P<0.05).The global omnibus test of the prediction model of perioperative allogeneic RBC transfusion for elderly hip fracture patients based on the results of multifactor logistic regression analysis was statistically significant(χ2=73.585,P<0.001).Hosmer and Lemeshow test yielded the goodness of fit of the model(χ2=9154,P=0.226),indicating that the model had a good fit.The area under receiver operating characteristic(ROC)curve(AUC)of the model to predict perioperative allogeneic RBC transfusion was 0.851,with sensitivity of 79.50%and specificity of 80.50%.Conclusion Perioperative allogeneic RBC transfusion in elderly patients with hip fractures is affected by many factors,such as advanced age,low BMI,intertrochanteric fractures,low Hb,low HCT,low ALB,high Cr and grade III ASA physical status classification and above on admission,general anesthesia,long surgical time,great intraoperative bleeding and postoperative intubation of drainage tube.A prediction model to is built to favor the development of individualized perioperative allogeneic RBC transfusion in elderly patients with hip fractures.
elderly patientship fractureperioperative periodallogeneic red blood cell transfusion
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