Summary

Perioperative high hidden blood loss (HBL) is a serious complication of total hip replacement, which can not only increase the risk and complications of the perioperative period, but also affect the recovery of joint function after surgery. At present, no evidence has supported the impact of perioperative function exercises on hidden blood loss in elderly patients with total hip replacement.

Abstract

Purpose

To investigate the effects of initiative and passive perioperative function exercises on hidden blood loss (HBL), and to identify the correlations between HBL and perioperative function exercises, providing new tactics and therapeutic approaches for the prevention and treatment of the high HBL.

Methods

230elderly patients with hip fractures aged 67～87 years (average age of 73.6) were included underwent total hip replacement. By the intensity and the manner of perioperative function exercises, patients were randomly divided into four groups: group A (little initiative function exercises), group B (little initiative and passive function exercises), group C (normal initiative function exercises), group D (normal initiative and passive function exercises). The true total blood loss, HBL and their proportion on the original blood volume and total blood loss was calculated depending on height, weight, intra - operative blood loss, post - operative blood loss, pre -and post- operative Hct, and blood transfused. According to the proportion of mean HBL on total blood loss, patients were divided into low HBL group and high HBL group. Then, we analyzed the correlations between HBL and function exercises.

Results

The mean HBL was 516.9 ml, 41.9 % of the total blood loss. Thereinto, in group A, the mean HBL was 694.9 ml, 49.3 %of the TBL, the prevalence of high HBL was 66.7 % (34/51 cases); In group B, the mean HBL was 624.6 ml, 46.9 % of the TBL, the prevalence of high HBL was59.3 % (32/54 cases); In group C, the mean HBL was 445.5 ml, 38.4 % of the TBL, the prevalence of high HBL was 30.8 % (20/65 cases); In group D, the mean HBL was 346.3 ml, 32.3 % of the TBL, the prevalence of high HBL was 20.0 % (12/60 cases); The expression levels of the prevalence of high HBL between any two groups, the difference was statistically significant (P<0.05). the incidence of high HBL was gradually diminished by the increase intensity of initiative function exercises, and was was gradually reduced by co- participation of the passive function exercises (P < 0.05);The mean HBL and their proportion on total blood loss were gradually diminished by the increase intensity of initiative function exercises (P < 0.05); the proportion of mean HBL on total blood loss of the normal initiative function exercises groups were gradually diminished by the increase intensity of passive function exercises (P < 0.05), while the little initiative function exercises groups were not (P >0.05). the prevalence of low HBL was 57.4 % (132 cases), the prevalence of high HBL was 42.6 % (98 cases); the proportion of little initiative function exercises patients on high HBL group was obviously higher than that in the low HBL group (P < 0.05), the proportion of normal initiative function exercises patients on high HBL group was obviously lower than that in the low HBL group (P < 0.05).

Conclusion

The intensity and the manner of perioperative function exercises were strongly associated with the HBL in elderly patients with total hip replacement. The initiative combined with the passive function exercises could be effectively prevent and reduce the incidence of high HBL.