Blood transfusion and overall quality of life after hip fracture in frail elderly patients--the transfusion requirements in frail elderly randomized controlled trial.
BACKGROUND
We examined possible associations between different red blood cell (RBC) transfusion strategies, overall quality of life (OQoL), and recovery of activities of daily living (ADL) in operated frail elderly hip fracture patients, and the possibility that OQoL was related to ADL recovery.


METHODS
A prospective, assessor-blinded, randomized controlled trial was carried out among 157 elderly residents (≥65 years) from nursing homes and sheltered housing facilities with Mini-Mental State Examination scores ≥5 points. Patients were assigned to either a restrictive RBC transfusion strategy [hemoglobin (Hb) < 9.7 g/dL, 6 mmol/L] or a liberal strategy (Hb < 11.3 g/dL, 7 mmol/L) during the first 30 days after surgery. An interview-based questionnaire, the depression list (DL) assessing OQoL, and the modified Barthel Index (MBI) assessing ADL performance, were conducted on day 30 and 1 year after hip fracture surgery. Sum-scores of DL, MBI, and their changes from day 30 until 1 year (expressing recovery) were compared between RBC transfusion groups. Possible associations between changes of DL and MBI sum-scores were tested for across total patient population.


RESULTS
There was no association between OQoL and RBC transfusion strategies on day 30 or at 1 year. The DL sum-score changes were similar for both groups, (ie, 1.06 points) [95% confidence interval (CI) -0.62, 2.76)] P = .21. The MBI sum-scores increased at 1 year following the liberal transfusion strategy (ie, by 6.86 points) (95% CI 0.41, 13.3) P = .03. Recoveries of OQoL and ADL were associated: β = -0.06 (95% CI -0.11, -0.01) P = .02.


CONCLUSIONS
According to our Hb threshold criteria, OQoL and RBC transfusion strategies for frail elderly hip fracture patients are not associated. However, for survivors with less severe dementia, ADL recovery after 1 year is greater following a liberal transfusion strategy than a restrictive strategy. OQoL progress and ADL recovery were associated.
Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark. Electronic address: meregreg@rm.dk.
Merete
M
Gregersen
Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark.
Lars Carl
LC
Borris
Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark.
Else Marie
EM
Damsgaard
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D005260:Female; D016330:Frail Elderly; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires
Hip fracture; blood transfusion; frail elderly; quality of life; recovery