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General Orthopaedics

POST OPERATIVE REDUCTION IN HAEMOGLOBIN LEVEL IS RELATED TO RISE IN TROPONIN T FOLLOWING HIP FRACTURE SURGERY

Combined Irish Orthopaedic Association, Welsh Orthopaedic Association, Scottish Orthopaedic Association (IOA, WOA, SOA)



Abstract

Background and Objective

Patients undergoing hip fracture surgery have a high peri-operative mortality rate. We performed a retrospective study to ascertain if there is any relation between postoperative haemoglobin (Hb) decrease and cardiac related events following the surgery.

Methodology

We carried out a retrospective study in this University Hospital's trauma unit. All patients operated for fracture neck of femur (hemiarthroplasty and DHS – Dynamic Hip Screw) between July 2006 and August 2008 were included in the study.

Electronic records from the trauma unit, pathology portal, operating theatre and blood bank were obtained to identify the pre-operative and post-operative Hb levels, amount of blood transfused and Troponin T (TnT) level.

Results

A total of 632 patients were operated for fracture neck of femur surgery during the study period of which 616 had complete perioperative blood results (DHS: 341; 80 male and 261 females and Hemiarthroplasty: 275; 68 male and 207 females). 60 patients had TnT levels performed within 10 days of the operation, thus suggesting possible cardiac related symptoms. Of these, 25 patients had a raised TnT (= 0.03). 24 (96%) of these patients had a post-operative Hb decrease compared with 550/591 (93%) patients without TnT (mean 2.3, range 0.1-5.6 g/dl compared with a mean of 2.4 and a range of 0-7 g/dl).

Scatter diagram illustrated a positive correlation between post-operative Hb drop and TnT rise. Linear regression analysis concluded that a post-operative Hb drop is significantly correlated to TnT rise at the 10% level (p = 0.064).

Conclusions

Post-operative Hb decline correlates with a raised TnT. As a standard protocol, post-operative bloods including Hb are performed the day after surgery. Given the correlation demonstrated, we recommend Hb levels to be analysed on day of surgery, to effectively manage low Hb levels before cardiac symptoms can develop.