In this research, data of 300 pelvic fracture patients were obtained from multi-center electronic information systems. After exclusion, 103 patients were divided into three groups according to their transfusion of PRBCs during their definitive stabilization surgeries. 52 (48.1%) patients received 1–3 units PRBCs, 39 (37.9%) patients received 3–6 units PRBCs, and 12 (11.7%) patients received> 6 units PRBCs.
As demonstrated in Table 1, the median age of the patients was 49 years (IQR 32–59) and 57 (55.3%) patients were male. Mechanisms of injury were mainly traffic accidents (58.3%), followed by falls from height (25.2%), crushes (8.7%), falls on the ground (5.8%), and others (1.9%). Tile classifications of fracture types were identified by an experienced orthopaedic surgeon. Patients in three groups did not differ in age, gender, co-existing diseases, injury mechanisms, fracture types, or fracture sites. 4 (33.3%) of 12 patients who were diagnosed with hemorrhagic shock at admission were in the>6U PRBCs group (p = 0.039). Patients in the >6U PRBCs group had higher AIS (p = 0.013). The median time from injury to surgery was 7 hours (IQR 2–12) and the preoperative Hb was 98.7 ± 18.6 g/L. No significant differences in respect to ASA, the time from injury to surgery and the preoperative Hb were found among three groups.
The routine blood test, serum liver function test, serum kidney function test and coagulation test on admission were summarized in Table 2. No significant difference on the routine blood test was found among three groups except the blood platelet count (BPC). The BPC was lower in the >6U PRBCs group (p = 0.011). Parameters of the blood chemistry test for the kidney function didn’t differ among three groups except Scr, which was significant higher in the >6U PRBCs group (p = 0.007). From the results of the blood chemistry test for the liver function, we could see that total serum protein (TSP), serum albumin (SA), and serum globulin (SG) were significant lower in the >6U PRBCs group (all p<0.01). In regard to conventional coagulation test, PT and APTT prolonged in the >6U PRBCs group (all p<0.05).
As shown in Table 3, there were no differences between three groups about the preoperative and postoperative transfusions of PRBCs (all p>0.05). The median intraoperative transfusion of PRBCs was 1.5 units (IQR 0–2) in the <3U group, 4 units (IQR 3.6–4) in the 3–6U PRBCs group and 9.75 units (IQR 8.3–10) in the >6U PRBCs group(p<0.01). Intraoperative fluid intake and output were exhibited in Fig. 1, compared with2500 mL (IQR 1500–3200) in the <3U group, the median intraoperative fluid intake was significantly higher with 3975 mL (IQR 3025–5687.5) in the 3–6U group and 5475 mL (IQR 3812.5–7462.5) in the >6U group (all p<0.01). Compared with 600 mL (IQR 300–1050) in the <3U group, the median fluid output was significant higher with 1585 mL (IQR 1000–2390) in the 3–6U group and 2375 mL (IQR 1225–3900) in the >6U group (all p<0.01). Seen from Table 4, there were no differences among three groups on types of procedures regarding the fracture sites performed in definitive orthopaedic stabilization surgeries (all p>0.05). The fracture quality reduction based on the plain film was assessed by an experienced orthopaedic surgeon, using a Matta scoring system [9], which is based on the maximum displacement on the radiograph of the anteroposterior and oblique. “Excellent” represents the hip joint normal, “good” represents mild changes (<1mm), "fair" represents intermediate changes (2~3mm) and "poor" represents major changes (>3mm). No significant differences of complications, Mata scores and clinical outcomes were observed among three groups. Patients in the >6U PRBCs group underwent more subsequent surgeries after the orthopaedic surgeries and were associated with longer length of ICU stays (all p<0.01). No significant differences among three groups on complications were observed in Fig. 2. Six patients developed complications, which included pneumonia, anaphylaxis, infection, fever, deep venous thrombosis, and pressure ulcer.
Multivariate analyses were respectively established to discover the effects of intraoperative transfusion of PRBCs, presence of hemorrhagic shock, AIS, BPC, Scr, SA, SG, PT, APTT, and intraoperative fluid output on overall transfusions and clinical outcomes. TSP was with significant difference in univariate analyses but was eliminated in multivariate analyses, and multicollinearity diagnostics confirmed no multicollinearities existed among other factors. The results were concluded in Table 5. The increased intraoperative transfusion of PRBCs was an independent factor which was associated with increased transfusions of PRBCs (p<0.01) and FFP (p = 0.027), numbers of subsequent surgeries after orthopaedic fixation surgeries (p = 0.002), and prolonged ICU days (p<0.01).