[Preoperative concentration of plasma fibrinogen as a predictor of bleeding in total hip arthroplasty].

Abstract

Introduction: Total hip arthroplasty is popular for its success in treating coxarthrosis, its associated with substantial blood loss. Significant bleeding causes complications such as increase in hospitalization days, higher costs, exposing the patient to complications associated with blood transfusion. The aim of the study is to investigate the association between preoperative plasma fibrinogen concentration and trans-surgical bleeding and determine fibrinogen level cut-off to present greater trans-surgical bleeding.

Material and methods: Retrospective, observational, analytical study, from June to December 2020, including 227 patients with Kellgren and Lawrence scale IV coxarthrosis undergoing primary total hip arthroplasty, beneficiaries, older than 18 years, without liver or hematological diseases, and history of significant surgical bleeding.

Results: Mean preoperative hemoglobin value was 14.6 ± 1.3 g/dl, after surgery (48 hours) 10.5 ± 1.4 g/dl; decrease of 4.1 ± 1.2 g/dl (p 0.0001). Mean preoperative hematocrit value 43% [41-45], after the procedure; 32% [29-35]; decrease of 11% [8-14] (p 0.0001). 98 patients had intraoperative bleeding 300 ml, 129 had 300 ml; 61.2% of patients with bleeding greater than 300 ml had fibrinogen values below the cut-off point (388 mg/dl).

Conclusion: In postoperative patients, preoperative fibrinogen levels 388 mg/dl and age 58 years were associated with an increased risk of OR = 0.18 (95% CI 0.10-0.32) of presenting trans-surgical bleeding 300 ml, with a decrease in Hb of 4.1 ± 1.2 g/dl (p = 0.0001) and Hto of 11% [8-14] (p = 0.0001) between the pre and postoperative period in 48 hours.