Contact Thomas.Naylor@doctors.org.uk  for more information

Background/Rationale

 

Hip fractures are associated with significant morbidity and mortality. A number of strategies have been introduced to try and improve outcomes (National Hip Fracture Database, Best Practice Tariff, local protocols and procedures).

 

Anaemia is linked with mortality in patients following a hip fracture. A low haemoglobin is one of the variables used in calculating the Nottingham Hip Fracture Score, a score used to predict mortality following a hip fracture.

 

Transfusion of blood products, however, is associated not only with cost but also morbidity and therefore should not be undertaken lightly.

 

Alternative methods of reducing blood loss and as a result anaemia and the need for transfusion, is therefore desirable.

 

Tranexamic acid has been shown to reduce blood loss and reduce the need for transfusions, without an increase in complications, in several independent studies investigating its use in patients undergoing surgery for hip fractures. Two systematic reviews of these studies have shown similar conclusions.

 

Tranexamic acid is cheap and widely available. It is now commonly used in orthopaedic procedures, such as joint replacement surgery, and there are many publications reporting its effectiveness in reducing blood loss.

 

Despite this evidence, anecdotally, the use of Tranexamic acid has not been widely introduced into the management of patients undergoing surgery for hip fractures. A local audit in Stepping Hill Hospital, Stockport, showed only around 25% of patients undergoing surgery for a hip fracture received peri-operative Tranexamic acid. We wish to quantify the use of Tranexamic acid in patients undergoing surgery for hip fractures nationally.

 

Aims / Objectives

 

Aim:

 

To assess if patients undergoing surgery for a neck of femur fracture are receiving peri-operative Tranexamic acid.

 

Objective:

 

To improve the administration of peri-operative tranexamic acid in patients undergoing surgery for a neck of femur fracture (if required) and to improve outcomes (if possible).