title: Blood transfusion and risk of infection in frail elderly after hip fracture surgery: the TRIFE randomized controlled trial.
abstract: OBJECTIVE
  It is still under debate that red blood cell (RBC) transfusions might increase the risk of healthcare-associated infections after hip fracture surgery. Previously, we found that a liberal RBC transfusion strategy improved survival in nursing home residents. Our aim, therefore, was to investigate whether a more liberal RBC transfusion strategy was associated with a higher infection risk in frail elderly hip fracture patients.
  
  
  METHODS
  Prospective, assessor-blinded, randomized and controlled trial.
  
  
  METHODS
  Orthopedic ward, Geriatric ward, and Hospital-at-home.
  
  
  METHODS
  284 consecutively hospital-admitted elderly with hip fracture from nursing homes or sheltered housing facilities were included.
  
  
  METHODS
  A restrictive RBC transfusion strategy (hemoglobin <9.7 g/dL; 6 mmol/L) compared with a liberal strategy (hemoglobin <11.3 g/dL; 7 mmol/L) administered within 30 days after surgery.
  
  
  METHODS
  Leukocytes and C-reactive protein (CRP) in repeated blood samples within 30 days, and number of all infections (pneumonia, urinary tract infection, and other infections) within 10 days.
  
  
  RESULTS
  88 % of the patients received a RBC transfusion. A median of 1 RBC unit (interquartile range (IQR): 1-2) was transfused for the restrictive strategy group versus 3 RBC units (IQR: 2-5) for the liberal group. Leukocytes and CRP measurements were similar for both groups. Rates of infection were 72 % for the restrictive group compared to 66 % for the liberal group (risk ratio 1.08; 95 % confidence interval 0.93-1.27, p value 0.29).
  
  
  CONCLUSIONS
  A more liberal RBC transfusion strategy was not associated with higher risk of infection among residents from nursing homes or sheltered housing undergoing hip fracture surgery.
authors.affiliation: Department of Geriatrics, Aarhus University Hospital, P.P. Oerumsgade 11, 8000, Århus C, Denmark, meregreg@rm.dk.
authors.forename: Merete
authors.initials: M
authors.lastname: Gregersen
authors.forename: Else Marie
authors.initials: EM
authors.lastname: Damsgaard
authors.forename: Lars Carl
authors.initials: LC
authors.lastname: Borris
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D003428:Cross Infection / Q000209:etiology*; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D016330:Frail Elderly; D006620:Hip Fractures / Q000601:surgery*; D006707:Homes for the Aged; D006760:Hospitalization; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D009735:Nursing Homes; D018410:Pneumonia, Bacterial / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology; D014552:Urinary Tract Infections / Q000209:etiology
chemical_list: D002097:C-Reactive Protein