title: Postoperative blood transfusion strategy in frail, anemic elderly patients with hip fracture: the TRIFE randomized controlled trial.
abstract: OBJECTIVE
  Hip fracture (HF) in frail elderly patients is associated with poor physical recovery and death. There is often postoperative blood loss and the hemoglobin (Hb) threshold for red blood cell (RBC) transfusions in these patients is unknown. We investigated whether RBC transfusion strategies were associated with the degree of physical recovery or with reduced mortality after HF surgery.
  
  
  METHODS
  We enrolled 284 consecutive post-surgical HF patients (aged ≥ 65 years) with Hb levels < 11.3 g/dL (7 mmol/L) who had been admitted from nursing homes or sheltered housing. Allocation was stratified by residence. The patients were randomly assigned to either restrictive (Hb < 9.7 g/dL; < 6 mmol/L) or liberal (Hb < 11.3 g/dL; < 7 mmol/L) RBC transfusions given within the first 30 days postoperatively. Follow-up was at 90 days.
  
  
  RESULTS
  No statistically significant differences were found in repeated measures of daily living activities or in 90-day mortality rate between the restrictive group (where 27% died) and the liberal group (where 21% died). Per-protocol 30-day mortality was higher with the restrictive strategy (hazard ratio (HR) = 2.4, 95% CI: 1.1-5.2; p = 0.03). The 90-day mortality rate was higher for nursing home residents in the restrictive transfusion group (36%) than for those in the liberal group (20%) (HR = 2.0, 95% CI: 1.1-3.6; p = 0.01).
  
  
  CONCLUSIONS
  According to our Hb thresholds, recovery from physical disabilities in frail elderly hip fracture patients was similar after a restrictive RBC transfusion strategy and after a liberal strategy. Implementation of a liberal RBC transfusion strategy in nursing home residents has the potential to increase survival.
authors.affiliation: Departments of Geriatrics and.
authors.forename: Merete
authors.initials: M
authors.lastname: Gregersen
authors.forename: Lars C
authors.initials: LC
authors.lastname: Borris
authors.forename: Else Marie
authors.initials: EM
authors.lastname: Damsgaard
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood / Q000628:therapy*; D019644:Arthroplasty, Replacement, Hip; D017707:Erythrocyte Transfusion / Q000379:methods*; D005260:Female; D005593:Fracture Fixation, Internal; D016330:Frail Elderly; D006454:Hemoglobins / Q000378:metabolism; D006620:Hip Fractures / Q000401:mortality / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D009735:Nursing Homes; D011182:Postoperative Care / Q000379:methods*; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D011446:Prospective Studies; D015996:Survival Rate
chemical_list: D006454:Hemoglobins