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

BMC Anesthesiology

Kamilla Nielsen⁶  Pär I Johansson⁴  Benny Dahl⁵  Michael Wagner²  Britt Frausing²  Jens Børglum³  Kenneth Jensen³  Jens Stürup⁵  Jesper Hvolris¹  Lars S Rasmussen⁶ 

[1] Department of Orthopedic Surgery, Copenhagen University Hospital, Bispebjerg, Denmark

[2] Department of Occupational Therapy and Physiotherapy, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Denmark

[3] Department of Anaesthesia and Intensive Care Medicine, Copenhagen University Hospital, Bispebjerg, Denmark

[4] Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Denmark

[5] Department of Orthopaedic Surgery, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Denmark

[6] Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Denmark

关键词: Hip surgery;    Ambulation;    Red blood cells;    Haemoglobin concentration;    Transfusion threshold;   

Others  :  1084357
DOI  :  10.1186/1471-2253-14-89

 received in 2013-10-06, accepted in 2014-09-29,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Nielsen et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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