title: A restrictive policy for red blood cell transfusion in older hip fracture patients: experiences from a patient register.
abstract: BACKGROUND
  Allogeneic red blood cell transfusions (ABT) are common in older hip fracture patients. Recent research supports a restrictive transfusion policy. The aim was to study variation in hemoglobin (Hb) concentration, and clinical outcomes in these patients.
  
  
  RESULTS
  Cross-sectional study with one-year follow-up in an orthogeriatric unit. Data were obtained from a quality register with demographic and medical information collected by an interdisciplinary team. 106 (22 %) of the 491 patients admitted from September 2011 throughout September 2012 (76 % women, mean age 85 years) received ABT. When given ABT, 80 % had Hb <80 g/l and mean Hb was 78 g/l. Mean Hb, regardless ABT, showed variation from 125 g/l (±16) on admission to 106 g/l (±17), 101 g/l (±16) and 102 g/l (±14) on 1st, 3rd and 5th postoperative day respectively. Patients with per-/subtrochanteric fractures more often received ABT than those with femur neck fractures (p < 0.001), 70 % of the patients receiving ABT had a per-/subtrochanteric fracture. Patients who received ABT were older, had more chronic diseases and lower mean Hb throughout the hospital stay. Length of stay was longer (median 7 vs. 6 days, p = 0.01), and medical complications more common. In-hospital and 30-day mortalities were similar in patients given ABT and in those who were not, but 1-year mortality was higher among patients who were given ABT (p = 0.008).
  
  
  CONCLUSIONS
  Hb had a tendency to fall during the three first days after surgery and seemed to be stabilized on day 5. Patients who received ABT had poorer health, but not significantly higher short-term mortality. This study demonstrates a restrictive transfusion policy.
authors: Department of Surgery, Diakonhjemmet Hospital, Oslo, Norway. metteirene.martinsen@diakonsyk.no.
authors: Mette Irene
authors: MI
authors: Martinsen
authors: Department of Surgery, Diakonhjemmet Hospital, Oslo, Norway. haldorvalland@hotmail.com.
authors: Haldor
authors: H
authors: Valland
authors: Department of Surgery, Diakonhjemmet Hospital, Oslo, Norway. ludvig.fjeld.solheim@diakonsyk.no.
authors: Ludvig Fjeld
authors: LF
authors: Solheim
authors: Department of Surgery, Diakonhjemmet Hospital, Oslo, Norway. kristin.holvik@fhi.no.|Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway. kristin.holvik@fhi.no.
authors: Kristin
authors: K
authors: Holvik
authors: Department of Medicine, Diakonhjemmet Hospital, Box 23 Vinderen, 0319, Oslo, Norway. ahranhoff@yahoo.no.|Department of Clinical Science, University of Bergen, Bergen, Norway. ahranhoff@yahoo.no.
authors: Anette
authors: A
authors: Ranhoff
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017707:Erythrocyte Transfusion / Q000401:mortality; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006620:Hip Fractures / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007902:Length of Stay; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D015995:Prevalence; D012042:Registries; D014184:Transplantation, Homologous
chemical_list: D006454:Hemoglobins