Elsevier

Injury

Volume 44, Issue 12, December 2013, Pages 1916-1918
Injury

Randomised trial of blood transfusion versus a restrictive transfusion policy after hip fracture surgery

https://doi.org/10.1016/j.injury.2013.04.033Get rights and content

Abstract

Background

Debate exists as to what should be the transfusion threshold for patients with anaemia after hip fracture surgery.

Methods

A total of 200 patients aged 60 years and above with a haemoglobin level of between 8.0 and 9.5 g dl−1 after hip fracture surgery were randomised to receive a transfusion to raise the haemoglobin to at least 10.0 g dl−1 or not to have a transfusion unless definite symptoms of anaemia became apparent. Patients were followed up for 1 year.

Results

There was no statistically significant difference in the outcomes of mortality, hospital stay, regain of mobility or complications between the two groups.

Conclusions

This study confirms other recent research studies which found that reducing the transfusion threshold to 8.0 g dl−1 appears to be a safe practice for this group of patients.

Section snippets

Patients and methods

Patients treated at a single centre with a proximal femoral (hip) fracture were considered for inclusion in the study if their haemoglobin measured on the first or second day after surgery was between 8.0 and 9.5 g dl−1 and no definite symptoms of anaemia were present. Patients with haemoglobin of <8.0 g dl−1 were not included and received a blood transfusion and those with haemoglobin >9.5 g dl−1 were not transfused. Exclusion criteria were age <60 years, patients unwilling or unable to provide

Results

Table 1 details the characteristics of the patients included in the study. Both groups of patients were comparable with no statistically significant difference between the two groups. All the patients who did not receive general anaesthesia had regional anaesthesia. All patients in the transfusion group received a blood transfusion with a mean of 1.9 U of blood (16 patients received one unit, 92 two units, one three units and four patients received four units). Eleven patients allocated to the

Discussion

This study showed no difference in outcome related to transfusion. These conclusions need to be interpreted with caution as it is possible that smaller but clinically relevant differences in outcome may still exist, but they have not been demonstrated in this study due to the limited number of patients included. The strengths of this study are the secure randomisation of patients, no loss of patients to follow-up and full reporting of outcomes.

We did not exclude from this study those patients

Conflict of interest

The author does not have any conflict of interest with this article.

Source of funding

There was no external funding for this study.

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