Impact of Early versus Delayed Surgical Intervention in Geriatric Acetabular Fractures on Transfusion Requirements.

Abstract

Objective: To determine if fixation within 48 hours from injury reduces risk for transfusion in geriatric patients with acetabular fractures.

Methods: Design: Retrospective.

Setting: Single Level I Trauma Center (2010-2023).

Patient selection criteria: Patients above 65 years of age with open reduction internal fixation (ORIF) for acetabular fractures (AO/OTA 62) were identified using Current Procedural Terminology codes. Patients managed non-operatively, with closed reduction percutaneous fixation, acute total hip arthroplasty, staged ORIF and patients with operations with any blood loss prior to acetabular ORIF were excluded.

Outcome measures and comparisons: The primary outcome was differences in transfusion requirements between patients who had early fixation (within 48 hours) and those who had delayed fixation (after 48 hours). Secondary outcomes included differences in length of stay (LOS), estimated blood loss (EBL), surgical site infection (SSI), and mortality. Logistic regression for likelihood of transfusion during hospitalization and SSI were done and included surgical timing, surgical approach, hemoglobin at admission, TXA administration, preoperative transfusion, and intraoperative transfusion.

Results: Of 132 patients included in the study, 86 (65.9%) underwent early fixation and 45 (34.1%) delayed fixation. The early fixation group had an average age of 73.8 (65-89) and the delayed group of 73.4 (65-89) (p=0.797) and both had male majority (63.2% and 73.3%, respectively). Early fixation group had less injuries from high energy trauma (52.3% vs 75.0%;p=0.013) but no difference in injury severity scores (9 vs 11.1;p=0.184) or complex fracture patterns (69.0% vs 68.9%;p=0.993). Patients with early fixation had higher rates of anterior approaches (58.6% vs 35.6%;p=0.042) and shorter surgical time (136 vs 169 min;p=0.013). There was no statistically significant difference in rates of transfusion between early and delayed fixation (62.1% vs 73.3%;p=0.196). Early fixation group had more units of blood during overall hospital stay (5.1 vs 2.4; p=0.003). Early fixation was also associated with shorter LOS (7.1 days vs 13.5 days; p<0.001). There was no significant difference in EBL, SSI or mortality. Surgical timing did not independently influence SSI risk (p=0.913) or likelihood of transfusion (p=0.273) but early fixation increased the volume of units transfused (p=0.0143).

Conclusion: Early fixation was associated with shorter LOS and operative times. Although the overall transfusion rate did not differ significantly between groups, early fixation demonstrated an increased risk for a higher volume of blood transfused among patients requiring transfusions. Surgical timing did not influence risk for SSI or likelihood of transfusion during hospital stay.

Level of evidence: III.