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Master of Public Health

Early acetabular fracture repair through an anterior approach is associated with increased blood loss

AUTHORS

Ambrose M , Schulman JE , Kuenze C , Hymes RA , Holzman M , Malekzadeh AS , Ray-Zack M , Gaski GE , . Journal of orthopaedic trauma. 2024 1 9; ().

ABSTRACT

OBJECTIVES: To determine whether the timing of acetabular fracture fixation through an anterior approach influences estimated and calculated perioperative blood loss.

DESIGN: Retrospective cohort study.

SETTING: Level 1 trauma center from 2013 to 2021.

PATIENT SELECTION CRITERIA: Patients age >18 treated with acetabular fracture fixation through an anterior-based approach.

OUTCOME MEASURES AND COMPARISONS: The primary outcome was calculated blood loss (CBL). Secondary outcomes were estimated blood loss (EBL) reported by surgeon and anesthesia, and blood transfusion requirements. Comparisons of blood loss were made at discrete post-injury time thresholds (24, 36, and 48 hours) and on a continuous basis.

RESULTS: 108 patients were studied. The mean age was 65 and 73% of patients were male. Earlier fixation of acetabular fractures resulted in greater CBL and EBL (surgeon and anesthesia) compared to later fixation when analyzed on a continuum and at specific time points (24, 36, and 48 hours). Mean CBL in patients treated earlier (< 48hrs, 2539 ml +/-1194) was significantly greater than those treated later (>48 hrs, 1625 ml +/-909; p<0.001). Fracture repair before 48 hours post-injury was associated with a 3 times greater risk of >2000 ml of CBL (p=0.006). This did not result in differences in transfusion rates between groups at 24 hours (p=0.518), 36 hours (p=1.000) or 48 hours (p=0.779).

CONCLUSIONS: Delaying fixation of acetabular fractures treated through an anterior approach for 48 hours post-injury may significantly reduce perioperative blood loss.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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