None listed
Conditions
Brief summary
In patients with hip fracture, low haemoglobin (Hb) levels are associated with post-operative complications, mortality, and increased hospital Length of Stay (LOS). A pre-operative Hb is taken on admission to the Emergency Department at Sir Charles Gairdner Hospital (SCGH). At the time of surgery, admission Hb levels may not be reliable indicators of current patient Hb status due to continual acute fracture-related blood loss, haemo-concentration and delays to surgery. This cohort study will investigate if an intervention of an Hb test immediately before surgery will improve patient outcomes. We will compare outcomes between 300 prospective patients and 300 retrospective patients. The outcome measures include hospital LOS, use of blood transfusions, Post-Anaesthetic Care Unit LOS, post-operative complications, admission to critical care areas, and survival to discharge. We foresee the results of this study may improve patient outcomes.
Interventions
Currently, a pre-operative Haemoglobin (Hb) level check is only performed in patients with hip fracture on admission to the Emergency Department approximately 16-48hours before surgery. Other studies have identified that the majority of blood loss a hip fracture patient experiences happens prior to surgery. Participants will be recruited into two groups; Retrospective group and Prospective group. The retrospective group will have received care according to the hospitals hip fracture care pathway
Currently, a pre-operative Haemoglobin (Hb) level check is only performed in patients with hip fracture on admission to the Emergency Department approximately 16-48hours before surgery. Other studies have identified that the majority of blood loss a hip fracture patient experiences happens prior to surgery. Participants will be recruited into two groups; Retrospective group and Prospective group. The retrospective group will have received care according to the hospitals hip fracture care pathway which guides only 1 pre-operative Hb level check is required to be performed on admission to the Emergency Department. The prospective group will have an additional Hb test using a point-of-care (HemoCue®) device immediately prior to surgery. The test may indicate acute fracture related pre-operative blood loss and/or diagnose anaemia. Treatment for anaemia such as; blood products, iron transfusion, oral midodrine, intravenous tranexamic acid, a change in the type of anaesthetic used or a delay in surgery may be provided to the patient at the anaesthetists discretion to prevent patient deterioration or minimise the risk of complications relating to blood loss/anaemia.
Sponsors
Sir Charles Gairdner Hospital
Study design
Allocation
Non-randomised trial
Intervention model
Other
Primary purpose
Diagnosis
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
50 Years to No maximum
Healthy volunteers
No
Inclusion criteria
• Patients with a low impact hip fracture requiring surgical intervention • Adults aged >50years • Patients able to consent to participate in the research study
Exclusion criteria
• Elective surgery • Hip fracture surgery to repair/replace fractures of pre-existing prosthesis or metal work • Jehovah’s Witnesses/ Patients refusing treatment for low Hb • Complicated fractures caused by cancer, metastases or tumour of the femur • Pregnancy
Outcome results
None listed