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Randomized Controlled Trial
. 2014 Oct 10:14:89.
doi: 10.1186/1471-2253-14-89. eCollection 2014.

Perioperative transfusion threshold and ambulation after hip revision surgery--a randomized trial

Kamilla Nielsen  1 , Pär I Johansson  2 , Benny Dahl  3 , Michael Wagner  4 , Britt Frausing  4 , Jens Børglum  5 , Kenneth Jensen  5 , Jens Stürup  3 , Jesper Hvolris  6 , Lars S Rasmussen  1
Affiliations
Randomized Controlled Trial

Perioperative transfusion threshold and ambulation after hip revision surgery--a randomized trial

Kamilla Nielsen et al. BMC Anesthesiol. .

Abstract

Background: Transfusion with red blood cells (RBC) may be needed during hip revision surgery but the appropriate haemoglobin concentration (Hb) threshold for transfusion has not been well established. We hypothesized that a higher transfusion threshold would improve ambulation after hip revision surgery.

Methods: The trial was registered at Clinicaltrials.gov ( NCT00906295). Sixty-six patients aged 18 years or older undergoing hip revision surgery were randomized to receive RBC at a Hb threshold of either 7.3 g/dL (restrictive group) or 8.9 g/dL (liberal group). Postoperative ambulation was assessed using Timed Up and Go-test (TUG) and ability to walk was also assessed daily by a physiotherapist blinded to the allocation.

Results: Fifty-three patients were able to perform the TUG and included in the analysis. The TUG could be completed in a median of 36 sec vs. 30 sec in the restrictive group and the liberal group, respectively (P = 0.02). The mean difference in TUG was 14.5 sec (95% CI 2.8-26.2 sec). No difference was found in the day patients could perform TUG or walk 10 meters. The Hb at the day of testing was 10.2 g/dL in the restrictive group and 9.9 g/dL in the liberal group. Only 26 patients received RBC.

Conclusions: A Hb transfusion threshold of 8.9 g/dL was associated with a statistically significantly faster TUG after hip revision surgery compared to a threshold of 7.3 g/dL but the clinical importance is questionable and the groups did not differ in Hb at the time of testing.

Keywords: Ambulation; Haemoglobin concentration; Hip surgery; Red blood cells; Transfusion threshold.

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Figures

Figure 1
Figure 1
Patient flow. Patient enrolment, randomization and treatment flow.
Figure 2
Figure 2
Haemoglobin concentration. Median haemoglobin concentration in patients undergoing hip revision surgery and randomized to a transfusion threshold of red blood cells of a haemoglobin concentration of 7.3 or 8.9 g/dL, restrictive group and liberal group, respectively. Plotted from before surgery until TUG was performed or patients were discharged from hospital. The number of patients is shown with digits above the graphs.
See this image and copyright information in PMC

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Pre-publication history
    1. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2253/14/89/prepub

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