The effects of liberal versus restrictive transfusion thresholds on ambulation after hip fracture surgery

Nicolai B Foss; Morten Tange Kristensen; Pia Søe Jensen; Henrik Palm; Michael Krasheninnikoff; Henrik Kehlet; Nicolai B Foss; Morten Tange Kristensen; Pia Søe Jensen; Henrik Palm; Michael Krasheninnikoff; Henrik Kehlet

doi:10.1111/j.1537-2995.2008.01967.x

The effects of liberal versus restrictive transfusion thresholds on ambulation after hip fracture surgery

Nicolai B Foss, Morten Tange Kristensen, Pia Søe Jensen, Henrik Palm, Michael Krasheninnikoff, Henrik Kehlet, Nicolai B Foss, Morten Tange Kristensen, Pia Søe Jensen, Henrik Palm, Michael Krasheninnikoff, Henrik Kehlet

Department of Clinical Medicine

124 Citations (Scopus)

Abstract

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.

Original language	English
Journal	Transfusion
Volume	49
Issue number	2
Pages (from-to)	227-34
Number of pages	7
ISSN	0041-1132
DOIs	https://doi.org/10.1111/j.1537-2995.2008.01967.x https://doi.org/10.1111/j.1537-2995.2008.01967.x
Publication status	Published - 2009

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Foss, N. B., Kristensen, M. T., Jensen, P. S., Palm, H., Krasheninnikoff, M., Kehlet, H., Foss, N. B., Kristensen, M. T., Jensen, P. S., Palm, H., Krasheninnikoff, M., & Kehlet, H. (2009). The effects of liberal versus restrictive transfusion thresholds on ambulation after hip fracture surgery. Transfusion, 49(2), 227-34. https://doi.org/10.1111/j.1537-2995.2008.01967.x, https://doi.org/10.1111/j.1537-2995.2008.01967.x

Foss, NB, Kristensen, MT, Jensen, PS, Palm, H, Krasheninnikoff, M, Kehlet, H , Foss, NB, Kristensen, MT, Jensen, PS, Palm, H, Krasheninnikoff, M & Kehlet, H 2009, 'The effects of liberal versus restrictive transfusion thresholds on ambulation after hip fracture surgery', Transfusion, vol. 49, no. 2, pp. 227-34. https://doi.org/10.1111/j.1537-2995.2008.01967.x, https://doi.org/10.1111/j.1537-2995.2008.01967.x

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title = "The effects of liberal versus restrictive transfusion thresholds on ambulation after hip fracture surgery",

abstract = "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.",

author = "Foss, {Nicolai B} and Kristensen, {Morten Tange} and Jensen, {Pia S{\o}e} and Henrik Palm and Michael Krasheninnikoff and Henrik Kehlet and Foss, {Nicolai B} and Kristensen, {Morten Tange} and Jensen, {Pia S{\o}e} and Henrik Palm and Michael Krasheninnikoff and Henrik Kehlet",

note = "Keywords: Aged; Aged, 80 and over; Blood Transfusion; Denmark; Double-Blind Method; Female; Hemoglobins; Hip Fractures; Hospitalization; Humans; Length of Stay; Male; Perioperative Care; Practice Guidelines as Topic; Retrospective Studies; Treatment Outcome; Walking",

year = "2009",

doi = "10.1111/j.1537-2995.2008.01967.x",

language = "English",

volume = "49",

pages = "227--34",

journal = "Transfusion",

issn = "0041-1132",

publisher = "Wiley-Blackwell",

number = "2",

}

TY - JOUR

T1 - The effects of liberal versus restrictive transfusion thresholds on ambulation after hip fracture surgery

AU - Foss, Nicolai B

AU - Kristensen, Morten Tange

AU - Jensen, Pia Søe

AU - Palm, Henrik

AU - Krasheninnikoff, Michael

AU - Kehlet, Henrik

AU - Foss, Nicolai B

AU - Kristensen, Morten Tange

AU - Jensen, Pia Søe

AU - Palm, Henrik

AU - Krasheninnikoff, Michael

AU - Kehlet, Henrik

N1 - Keywords: Aged; Aged, 80 and over; Blood Transfusion; Denmark; Double-Blind Method; Female; Hemoglobins; Hip Fractures; Hospitalization; Humans; Length of Stay; Male; Perioperative Care; Practice Guidelines as Topic; Retrospective Studies; Treatment Outcome; Walking

PY - 2009

Y1 - 2009

N2 - 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.

AB - 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.

U2 - 10.1111/j.1537-2995.2008.01967.x

DO - 10.1111/j.1537-2995.2008.01967.x

M3 - Journal article

C2 - 19389209

SN - 0041-1132

VL - 49

SP - 227

EP - 234

JO - Transfusion

JF - Transfusion

IS - 2

ER -

The effects of liberal versus restrictive transfusion thresholds on ambulation after hip fracture surgery

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