Sixty five thousand patients break their hip every year in England, Wales and Northern Ireland. Almost all patients with a hip fracture require operative treatment; either internal fixation or arthroplasty in equal numbers. Despite efforts to rehabilitate these patients, outcomes following surgery are poor; 30-day mortality was 6.5% in 2016, with one-year mortality estimated to be 30%; furthermore, patients report a 25% reduction in health-related quality-of-life at 4 months, disability similar to that seen following a stroke.
Patients admitted with a hip fracture are typically elderly, frail and have multiple medical co-morbidities, including pre-fracture anaemia. A recent audit at a major trauma centre, demonstrated that 30% of patients admitted with a hip fracture received allogenic blood. Allogenic blood transfusions do not come without risks to patients. They cause an increased rate of local (e.g. wound) and systemic (e.g. pneumonia) infections in postoperative patients. This is attributable to the immunomodulatory effect of allogenic blood on the recipient. As well as causing infections allogenic blood use is independently associated with increased length of hospital stay in orthopaedic surgery.
Concerns regarding patient safety and the costs of allogenic blood have driven efforts to reduce transfusion rates.Intra operative cell salvage and autotransfusion is a method of collecting blood lost during surgery and transfusing it back to the patient. The cell salvage device filters, washes and centrifuges blood lost during surgery, to separate the red blood cells from non-cellular matter prior to intraoperative autotransfusion. Complications as a result of cell salvage are rare.
When considering whether to use cell salvage, patients with a hip fracture present a unique population. They have a high mortality, high transfusion rates and high degrees of pre-existing morbidity including anaemia. These considerations mean that there are large potential benefits of using cell salvage in this population. Using cell salvage to reduce the use of allogenic blood has the potential benefit to patients of improving their outcomes from hip fracture surgery, by reducing infections, length of stay and levels of anaemia.
We propose evaluating the clinical effectiveness of cell salvage in hip fracture surgery.
01/12/2021 Recruitment has been suspended to the trial following the advice of the study's Data and Safety Monitioring Committee and the Trial Steerring Committee. Recruitment is not beign suspended due to safety concerns. More information to follow.
03/02/2021 9 sites are open. Recruitment paused at some due to COVID-19 redeplyoment, so is the set up. Aneurin Bevan Health Bord is open to recruitment.
08/01/2021 Recruitment continues at sites who confirmed capacity despite current COVID-19 situation - this is much appreciated. Cardiff and Vale UHB is now open to recruitment!
02/12/2020 Six sites open across the UK with St. George's Hospital London, Medway Maritime Hospital, Royal Derby Hospital joining recently!
24/09/2020 The study continues seamlessly into the definitive stage and more sites are being set up
14/04/2020 Following successful recruitment during the feasibility stage, an amendment for transition into a full study was submitted and is now approved by Wales REC 5 Committee
22/03/2020 As a result of the Covid-19 Virus WHiTE 9 has currently suspneded recruitment.
21/01/2020 Great recruitment - we are planning the extension into full study! Get in touch white9@ndorms.ox.ac.uk and get involved!
18/11/2019 Three sites open, 38 patients recruited!
18/10/2019 Royal Berskshire recruited our first patient!
11/10/2019 Activated our first two sites to begin recruitment, University Hospital Coventry & Royal Berkshire Hospital.
11/10/2019 Been grated greenlight from OCTRU.
Inclusion criteria
- All patients, both those with and without capacity, presenting with a fracture of the hip (AO type A1-3 & ST and B1-3) who, in the opinion of the operating surgeon, would benefit from surgery
Exclusion criteria
- Patients younger than 60 years of age
- Patients undergoing percutaneous (cannulated) hip screw fixation
- Patients for whom the treating surgeon has already elected to use cell salvage (for example Jehovah Witness)
- Patients who have sustained a pathological fracture.
