title: Liberal or restrictive transfusion in high-risk patients after hip surgery.
abstract: BACKGROUND
  The hemoglobin threshold at which postoperative red-cell transfusion is warranted is controversial. We conducted a randomized trial to determine whether a higher threshold for blood transfusion would improve recovery in patients who had undergone surgery for hip fracture.
  
  
  METHODS
  We enrolled 2016 patients who were 50 years of age or older, who had either a history of or risk factors for cardiovascular disease, and whose hemoglobin level was below 10 g per deciliter after hip-fracture surgery. We randomly assigned patients to a liberal transfusion strategy (a hemoglobin threshold of 10 g per deciliter) or a restrictive transfusion strategy (symptoms of anemia or at physician discretion for a hemoglobin level of <8 g per deciliter). The primary outcome was death or an inability to walk across a room without human assistance on 60-day follow-up.
  
  
  RESULTS
  A median of 2 units of red cells were transfused in the liberal-strategy group and none in the restrictive-strategy group. The rates of the primary outcome were 35.2% in the liberal-strategy group and 34.7% in the restrictive-strategy group (odds ratio in the liberal-strategy group, 1.01; 95% confidence interval [CI], 0.84 to 1.22), for an absolute risk difference of 0.5 percentage points (95% CI, -3.7 to 4.7). The rates of in-hospital acute coronary syndrome or death were 4.3% and 5.2%, respectively (absolute risk difference, -0.9%; 99% CI, -3.3 to 1.6), and rates of death on 60-day follow-up were 7.6% and 6.6%, respectively (absolute risk difference, 1.0%; 99% CI, -1.9 to 4.0). The rates of other complications were similar in the two groups.
  
  
  CONCLUSIONS
  A liberal transfusion strategy, as compared with a restrictive strategy, did not reduce rates of death or inability to walk independently on 60-day follow-up or reduce in-hospital morbidity in elderly patients at high cardiovascular risk. (Funded by the National Heart, Lung, and Blood Institute; FOCUS ClinicalTrials.gov number, NCT00071032.).
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA. carson@umdnj.edu
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Carson
authors.forename: Michael L
authors.initials: ML
authors.lastname: Terrin
authors.forename: Helaine
authors.initials: H
authors.lastname: Noveck
authors.forename: David W
authors.initials: DW
authors.lastname: Sanders
authors.forename: Bernard R
authors.initials: BR
authors.lastname: Chaitman
authors.forename: George G
authors.initials: GG
authors.lastname: Rhoads
authors.forename: George
authors.initials: G
authors.lastname: Nemo
authors.forename: Karen
authors.initials: K
authors.lastname: Dragert
authors.forename: Lauren
authors.initials: L
authors.lastname: Beaupre
authors.forename: Kevin
authors.initials: K
authors.lastname: Hildebrand
authors.forename: William
authors.initials: W
authors.lastname: Macaulay
authors.forename: Courtland
authors.initials: C
authors.lastname: Lewis
authors.forename: Donald Richard
authors.initials: DR
authors.lastname: Cook
authors.forename: Gwendolyn
authors.initials: G
authors.lastname: Dobbin
authors.forename: Khwaja J
authors.initials: KJ
authors.lastname: Zakriya
authors.forename: Fred S
authors.initials: FS
authors.lastname: Apple
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Horney
authors.forename: Jay
authors.initials: J
authors.lastname: Magaziner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000145:classification / Q000628:therapy; D001803:Blood Transfusion / Q000706:statistics & numerical data; D017707:Erythrocyte Transfusion; D005260:Female; D005500:Follow-Up Studies; D006454:Hemoglobins; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011183:Postoperative Complications; D012307:Risk Factors; D016896:Treatment Outcome; D014946:Wound Infection
chemical_list: D006454:Hemoglobins