title: The risks of red cell transfusion for hip fracture surgery in the elderly.
abstract: OBJECTIVE
  The benefits and indications for blood transfusion among surgical patients are controversial. There is evidence which suggests that blood transfusion is associated with poor clinical outcomes and risks of infection, but there are few data in the elderly population.
  
  
  METHODS
  Data were collected on haemoglobin concentrations and transfusions in 919 patients undergoing hip fracture repair at a university hospital over a 2-year period. 28-day and 180-day mortality were specified as primary outcomes. A composite infection outcome (chest infections, urinary tract infections and wound infections) was the main secondary outcome. Preoperative, operative and/or postoperative transfusions were the main exposure variable. Regression analyses were used to explore the associations between transfusion and outcomes, adjusting for pre-defined preoperative variables.
  
  
  RESULTS
  300 patients (32·6%) were transfused at least once during their admission. There was no evidence of a significant difference in either 28-day survival or 180-day survival between transfused and non-transfused hip fracture patients. The transfused group had higher adjusted composite infection rate (HR, 1·91; 95% CI, 1·41-2·59, P < 0·001) and prolonged length of stay in hospital than the non-transfused group (HR, 1·15; 95% CI, 1·07, 1·23, P < 0·001). Anaemia at the time of admission, extra capsular fracture and using walking aids in an indoor setting were preoperative variables, which predicted the need for transfusion.
  
  
  CONCLUSIONS
  Among an elderly population with hip fracture, blood transfusion was not associated with changes in mortality, but was associated with an increased rate of postoperative infection. These data add to the wider literature about adverse clinical outcomes in patients receiving blood transfusions and emphasises the need for prospective trials to evaluate the role of transfusion in the elderly.
authors.affiliation: Clinical Directorate, NHS Blood & Transplant, Bristol, UK. ashokoohi@yahoo.com
authors.forename: A
authors.initials: A
authors.lastname: Shokoohi
authors.forename: S
authors.initials: S
authors.lastname: Stanworth
authors.forename: D
authors.initials: D
authors.lastname: Mistry
authors.forename: S
authors.initials: S
authors.lastname: Lamb
authors.forename: J
authors.initials: J
authors.lastname: Staves
authors.forename: M F
authors.initials: MF
authors.lastname: Murphy
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D006620:Hip Fractures / Q000097:blood* / Q000601:surgery*; D006801:Humans; D008297:Male; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome