title: Perioperative transfusion threshold and ambulation after hip revision surgery--a randomized trial.
abstract: BACKGROUND
  Transfusion with red blood cells (RBC) may be needed during hip revision surgery but the appropriate haemoglobin concentration (Hb) threshold for transfusion has not been well established. We hypothesized that a higher transfusion threshold would improve ambulation after hip revision surgery.
  
  
  METHODS
  The trial was registered at Clinicaltrials.gov ( NCT00906295). Sixty-six patients aged 18 years or older undergoing hip revision surgery were randomized to receive RBC at a Hb threshold of either 7.3 g/dL (restrictive group) or 8.9 g/dL (liberal group). Postoperative ambulation was assessed using Timed Up and Go-test (TUG) and ability to walk was also assessed daily by a physiotherapist blinded to the allocation.
  
  
  RESULTS
  Fifty-three patients were able to perform the TUG and included in the analysis. The TUG could be completed in a median of 36 sec vs. 30 sec in the restrictive group and the liberal group, respectively (P = 0.02). The mean difference in TUG was 14.5 sec (95% CI 2.8-26.2 sec). No difference was found in the day patients could perform TUG or walk 10 meters. The Hb at the day of testing was 10.2 g/dL in the restrictive group and 9.9 g/dL in the liberal group. Only 26 patients received RBC.
  
  
  CONCLUSIONS
  A Hb transfusion threshold of 8.9 g/dL was associated with a statistically significantly faster TUG after hip revision surgery compared to a threshold of 7.3 g/dL but the clinical importance is questionable and the groups did not differ in Hb at the time of testing.
authors.affiliation: Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Kragujevac, Denmark.
authors.forename: Kamilla
authors.initials: K
authors.lastname: Nielsen
authors.affiliation: Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Kragujevac, Denmark.
authors.forename: Pär I
authors.initials: PI
authors.lastname: Johansson
authors.affiliation: Department of Orthopaedic Surgery, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Kragujevac, Denmark.
authors.forename: Benny
authors.initials: B
authors.lastname: Dahl
authors.affiliation: Department of Occupational Therapy and Physiotherapy, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Kragujevac, Denmark.
authors.forename: Michael
authors.initials: M
authors.lastname: Wagner
authors.affiliation: Department of Occupational Therapy and Physiotherapy, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Kragujevac, Denmark.
authors.forename: Britt
authors.initials: B
authors.lastname: Frausing
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Copenhagen University Hospital, Bispebjerg, Denmark.
authors.forename: Jens
authors.initials: J
authors.lastname: Børglum
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Copenhagen University Hospital, Bispebjerg, Denmark.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Jensen
authors.affiliation: Department of Orthopaedic Surgery, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Kragujevac, Denmark.
authors.forename: Jens
authors.initials: J
authors.lastname: Stürup
authors.affiliation: Department of Orthopedic Surgery, Copenhagen University Hospital, Bispebjerg, Denmark.
authors.forename: Jesper
authors.initials: J
authors.lastname: Hvolris
authors.affiliation: Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Kragujevac, Denmark.
authors.forename: Lars S
authors.initials: LS
authors.lastname: Rasmussen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000592:standards*; D004434:Early Ambulation / Q000592:standards*; D005260:Female; D005440:Fluid Therapy; D006454:Hemoglobins / Q000032:analysis; D006615:Hip / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D059408:Pain Management; D010149:Postoperative Pain; D059035:Perioperative Period
chemical_list: D006454:Hemoglobins
keywords: Ambulation; Haemoglobin concentration; Hip surgery; Red blood cells; Transfusion threshold