The effects of liberal versus restrictive transfusion thresholds on ambulation after hip fracture surgery.
BACKGROUND
Perioperative anemia leads to increased morbidity and mortality and potentially inhibits rehabilitation after hip fracture surgery. As such, the optimum transfusion threshold after hip fracture surgery is unknown.


METHODS
A total of 120 elderly, cognitively intact hip fracture patients admitted from their own home were randomly assigned to receive transfusion at a hemoglobin threshold of 10.0 g per dL (liberal) versus 8.0 g per dL (restrictive) in the entire perioperative period. Patients were treated according to a well-defined multimodal rehabilitation program. Primary outcome was postoperative functional mobility measured with the cumulated ambulation score (CAS).


RESULTS
Patients in the liberal group received transfusions more frequently than those in the restrictive group (44 patients vs. 22 patients; p < 0.01) and received more transfusions during hospitalization (median, 2 units [interquartile range, 1-2] vs. 1 [1-2]; p < 0.0001). There were no significant differences in postoperative rehabilitation scores (CAS: median, 9 [9-15] vs. 9 [9-13.5]; p = 0.46) or in length of stay (median, 18 days vs. 16 days, respectively; p = 0.46). There were fewer patients in the liberal transfusion group with cardiovascular complications (2% vs. 10%; p = 0.05) and a lower mortality (0% vs. 8%; p = 0.02).


CONCLUSIONS
Although a liberal transfusion trigger did not result in increased ambulation scores, restrictive transfusion thresholds should be treated with caution in elderly high-risk hip fracture patients, until their safety has been proved in larger randomized studies.
Foss
Nicolai B
NB
Department of Anesthesia, Hvidovre University Hospital, Denmark. nbf@comxnet.dk
Kristensen
Morten Tange
MT
Jensen
Pia Søe
PS
Palm
Henrik
H
Krasheninnikoff
Michael
M
Kehlet
Henrik
H
D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D003718:Denmark; D004311:Double-Blind Method; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006620:Hip Fractures / Q000401:mortality / Q000534:rehabilitation / Q000601:surgery*; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D019990:Perioperative Care / Q000379:methods; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D016896:Treatment Outcome; D016138:Walking
D006454:Hemoglobins