• The Oxford Trauma Team

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.

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Recruitment Progress:
Latest participant recruited from: John Radcliffe Hospital
Date of most recent recruitment: Tuesday, 30th November 2021