title: The impact of a restrictive transfusion trigger on post-operative complication rate and well-being following elective orthopaedic surgery: a post-hoc analysis of a randomised study.
abstract: BACKGROUND
  Peri-operative red blood cell transfusions have been associated with post-operative complications in patients undergoing elective orthopaedic hip or knee replacement surgery.
  
  
  METHODS
  We performed a post-hoc analysis of data extracted from a randomised study on transfusion triggers using pre-storage leucocyte-depleted red blood cells. Patients who were assigned to the most restrictive transfusion policy ("restrictive group") were compared with patients who were assigned to the most liberal policy ("liberal group"). End-points were red blood cell use, hospital stay, haemoglobin levels, post-operative complications and quality of life scores.
  
  
  RESULTS
  Of 603 patients, 26.4% patients in the restrictive group and 39.1% in the liberal group were transfused (P =0.001). The rate of post-operative infections was lower, although not statistically significantly so, in the restrictive group than in the liberal group (5.4% vs. 10.2%, respectively) as was the rate of respiratory complications (1.7% vs. 4.9%, respectively), whereas hospital stay, cardiovascular complications and mortality rate were not different in the two groups. Quality of life scores were not associated with type of transfusion policy, the number of red blood cell transfusions or the transfusion status.
  
  
  CONCLUSIONS
  A restrictive transfusion protocol was not associated with worse outcome and resulted in a lower transfusion rate compared to the liberal policy. Well-being (quality of life) was not associated with transfusion policy or with red blood cell transfusions.
authors: Department of Research and Development, Sanquin Blood Bank South West Region, Leiden, The Netherlands. c.so@sanquin.nl
authors: Cynthia
authors: C
authors: So-Osman
authors: Rob
authors: R
authors: Nelissen
authors: Ronald
authors: R
authors: Brand
authors: Frank
authors: F
authors: Faber
authors: Ron Te
authors: RT
authors: Slaa
authors: Anne
authors: A
authors: Stiggelbout
authors: Anneke
authors: A
authors: Brand
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000209:etiology*; D017707:Erythrocyte Transfusion / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D007239:Infections / Q000209:etiology*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011788:Quality of Life; D012140:Respiratory Tract Diseases / Q000209:etiology*
references: Transfusion. 2005 Jan;45(1):103-10
references: 15647025
references: J Orthop Trauma. 2006 Nov-Dec;20(10):675-9
references: 17106377
references: Transfusion. 1995 Feb;35(2):150-6
references: 7825211
references: Transfusion. 2011 Jan;51(1):71-81
references: 20663113
references: Infect Control Hosp Epidemiol. 1992 Oct;13(10):606-8
references: 1334988
references: N Engl J Med. 2011 Dec 29;365(26):2453-62
references: 22168590
references: J Bone Joint Surg Br. 2000 May;82(4):561-5
references: 10855883
references: Ann Thorac Surg. 2009 Nov;88(5):1410-8
references: 19853083
references: Transfusion. 2012 Feb;52(2):261-70
references: 21810097
references: Anesth Analg. 2008 Apr;106(4):1056-61, table of contents
references: 18349173
references: Transfus Med. 2005 Oct;15(5):413-8
references: 16202056
references: Vox Sang. 2010 Jan;98(1):56-64
references: 19656349
references: Cochrane Database Syst Rev. 2010 Oct 06;(10):CD002042
references: 20927728
references: Transfusion. 2003 Apr;43(4):459-69
references: 12662278
references: Transfusion. 2011 Jan;51(1):8-10
references: 21219321
references: Surg Infect (Larchmt). 2009 Jun;10(3):277-83
references: 19566415
references: Transfusion. 2004 Apr;44(4):489-500
references: 15043563
references: JAMA. 2002 Apr 17;287(15):1968-71
references: 11960539