ArticleEuropean journal of orthopaedic surgery & traumatology : orthopedie traumatologie2025
Hemoglobin trends and transfusion risk in isolated femoral shaft fractures: a multi-year retrospective analysis.
Article in European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo examine hemoglobin trends following isolated femoral shaft fractures (FSF) and characterize patient profiles associated with transfusion needs for optimized patient management.
methodsDesign: Retrospective cohort study.
settingLevel 1 trauma center. Patient Selection Criteria: Patients aged > 18 years undergoing isolated femur fracture fixation (ICD-10 and CPT 27506). Outcome Measures and Comparisons: Hemoglobin (Hgb) was recorded at the ER, pre-operatively, and daily post-operatively and compared to baseline Hgb (pre-injury or ≥ 3 months post-injury). Total Hgb loss was calculated, correcting for transfusions. Demographics, injury mechanism (high/low energy), number of transfusions, and length of stay were collected. SPSS was used for analysis.
results540 patients were included. Baseline Hgb was 14.6 g/dL for males and 13.1 g/dL for females. Post-injury Hgb decreased to 13.8 g/dL and 11.9 g/dL, respectively. 48.5% of patients required transfusion (40.7% males, 61% females, p = 0.001). The age threshold for increased risk of receiving a transfusion was 60 years old. Patients between the ages of 60-80 had a higher rate of transfusions (65.94%) when compared to patients between the ages of 40-60 (38.38%). 80.49% of patients above the age of 80 received a transfusion and were 6.2 times more likely to receive a transfusion compared to patients under 40. The median length of stay (LOS) of a patient receiving a transfusion was 4 days, while the median LOS for a patient not receiving a transfusion was 2 days.
conclusionsHemoglobin (Hgb) progressively declines after femoral shaft fractures (FSFs), with the most significant drop occurring post-operatively. Older age and female sex were associated with increased transfusion needs. Transfusion is associated with an increase in the LOS. These findings emphasize the importance of monitoring Hgb trends and considering age and injury mechanisms when assessing transfusion risk in FSF patients. LEVEL OF EVIDENCE: Prognostic Level III.
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