AUDIT OF TRANSFUSION RATES IN HIP FRACTURES

Background Hip fractures are one of the leading causes of hospital admissions. Surgical treatment is often associated with significant blood loss, requiring post-operative erythrocyte transfusion. Aim To assess post-operative erythrocyte transfusion rates for hip fractures and evaluate the effect of tranexamic acid (TXA). Method All patients undergoing surgical repair of a hip fracture at RLBUHT between 1st April 2013 – 30th April 2014 were selected. Data regarding transfusion status and peri-operative TXA use was collected from electronic databases and case notes. Results 450 patients were admitted with a hip fracture, of whom 441 underwent surgery. Modalities of hip fixation included total hip replacement (THR, n=39), hemiarthroplasty (n=145), dynamic hip screw (DHS, n=116), cannulated hip screw (CHS, n=17) and long (n=71) and short (n=53) intramedullary hip screw (IMHS). 44.2% received a post-operative erythrocyte transfusion, with an average of 2.5 units per patient (range 1–9 units). With all study subjects included, the average transfusion rates for THR, hemiarthroplasty, DHS, CHS, long IMHS and short IMHS were 0.44 units, 0.78 units, 0.97 units, 0.47 units, 1.55 units and 1.19 units respectively. Data regarding intra-operative TXA administration was available for 318 (72.1%) patients, sixty-one of whom received TXA. 27.9% given TXA required a post-operative transfusion (range 0–6 units), compared to 35.4% of patient with no intra-operative TXA (range 0–11 units), p=0.142. Conclusion 44.2% of patients required an erythrocyte transfusion, with an average of 2.5 units per patient of those transfused. This is higher than rates quoted by other studies including Shokoohi et al who had a transfusion rate of 32.6%. Adherence to local transfusion protocols must be reviewed. There is a tendency for TXA to reduce post-operative transfusion requirements, however in this study, this did not reach statistical significance (p=0.142). A larger, randomised controlled trial is required to assess the role TXA in hip fracture surgery.