Document Detail


The effects of liberal versus restrictive transfusion thresholds on ambulation after hip fracture surgery.
MedLine Citation:
PMID:  19389209     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Perioperative anemia leads to increased morbidity and mortality and potentially inhibits rehabilitation after hip fracture surgery. As such, the optimum transfusion threshold after hip fracture surgery is unknown.
PATIENTS AND METHODS: A total of 120 elderly, cognitively intact hip fracture patients admitted from their own home were randomly assigned to receive transfusion at a hemoglobin threshold of 10.0 g per dL (liberal) versus 8.0 g per dL (restrictive) in the entire perioperative period. Patients were treated according to a well-defined multimodal rehabilitation program. Primary outcome was postoperative functional mobility measured with the cumulated ambulation score (CAS).
RESULTS: Patients in the liberal group received transfusions more frequently than those in the restrictive group (44 patients vs. 22 patients; p < 0.01) and received more transfusions during hospitalization (median, 2 units [interquartile range, 1-2] vs. 1 [1-2]; p < 0.0001). There were no significant differences in postoperative rehabilitation scores (CAS: median, 9 [9-15] vs. 9 [9-13.5]; p = 0.46) or in length of stay (median, 18 days vs. 16 days, respectively; p = 0.46). There were fewer patients in the liberal transfusion group with cardiovascular complications (2% vs. 10%; p = 0.05) and a lower mortality (0% vs. 8%; p = 0.02).
CONCLUSION: Although a liberal transfusion trigger did not result in increased ambulation scores, restrictive transfusion thresholds should be treated with caution in elderly high-risk hip fracture patients, until their safety has been proved in larger randomized studies.
Authors:
Nicolai B Foss; Morten Tange Kristensen; Pia Søe Jensen; Henrik Palm; Michael Krasheninnikoff; Henrik Kehlet
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Transfusion     Volume:  49     ISSN:  1537-2995     ISO Abbreviation:  Transfusion     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-04-24     Completed Date:  2009-05-29     Revised Date:  2011-04-04    
Medline Journal Info:
Nlm Unique ID:  0417360     Medline TA:  Transfusion     Country:  United States    
Other Details:
Languages:  eng     Pagination:  227-34     Citation Subset:  IM    
Affiliation:
Department of Anesthesia, Hvidovre University Hospital, Denmark. nbf@comxnet.dk
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00162617
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Blood Transfusion*
Denmark
Double-Blind Method
Female
Hemoglobins / analysis
Hip Fractures / mortality,  rehabilitation,  surgery*
Hospitalization
Humans
Length of Stay / statistics & numerical data
Male
Perioperative Care / methods
Practice Guidelines as Topic
Retrospective Studies
Treatment Outcome
Walking*
Chemical
Reg. No./Substance:
0/Hemoglobins
Comments/Corrections
Comment In:
Transfusion. 2009 Aug;49(8):1770; author reply 1770-1   [PMID:  19732405 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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