Mortality and Functional Outcomes of Liberal versus Restrictive Blood Transfusion in Elderly Patients after Hip...

There is ongoing debate on the haemoglobin level at which red cell transfusion should be administered following surgery. This study aimed to evaluate the benefits of a restrictive blood transfusion strategy and assess potential adverse effects of anaemia in the immediate postoperative phase, determining whether a liberal transfusion approach still remains necessary.

A randomized control trial compared two groups: Group 1, with a liberal blood transfusion strategy, and Group 2, with a restrictive blood transfusion protocol. Haemoglobin levels were measured on the 3rd and 12th postoperative days, and at 1-month follow-up. Clinical and functional evaluations were conducted at the 1-month follow-up.

There was no significant difference between the liberal and restrictive groups in 10 feet walking with support at 12 days and at 1 month. The restrictive group had a shorter hospital stay (17.57±4.66 days) compared to the liberal group (19.56±5.34 days). Incidence of surgical site infections were similar (4.0% in liberal, 2.0% in restrictive), and no mortalities were observed in either group at the 1-month follow-up.

Both liberal and restrictive transfusion strategies were similarly effective in terms of early postoperative mortality and functional mobility. However, patients in the liberal transfusion group had a significantly longer length of stay compared to the restrictive group. Leading us to conclude that a restrictive strategy is effective and beneficial for patients and hospitals provided there are no signs of anaemia or a haemoglobin drop below 8 g/dL.