title: The effects of liberal versus restrictive transfusion thresholds on ambulation after hip fracture surgery.
abstract: 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.
authors.affiliation: Department of Anesthesia, Hvidovre University Hospital, Denmark. nbf@comxnet.dk
authors.forename: Nicolai B
authors.initials: NB
authors.lastname: Foss
authors.forename: Morten Tange
authors.initials: MT
authors.lastname: Kristensen
authors.forename: Pia Søe
authors.initials: PS
authors.lastname: Jensen
authors.forename: Henrik
authors.initials: H
authors.lastname: Palm
authors.forename: Michael
authors.initials: M
authors.lastname: Krasheninnikoff
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
mesh_terms: 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
chemical_list: D006454:Hemoglobins