Blood transfusion and risk of infection in frail elderly after hip fracture surgery: the TRIFE randomized controlled trial

被引：32
作者：
Gregersen M. [1 ]
Damsgaard E.M. [1 ]
Borris L.C. [2 ]
机构：
[1] Department of Geriatrics, Aarhus University Hospital, P.P. Oerumsgade 11, Århus C
[2] Department of Orthopaedics, Aarhus University Hospital, Nørrebrogade 44, Århus C
来源：
European Journal of Orthopaedic Surgery & Traumatology | 2015年 / 25卷 / 6期
关键词：
Blood transfusion; Frail elderly; Hip fracture; Infection;
D O I：
10.1007/s00590-015-1609-2
中图分类号：
学科分类号：
摘要：
Objectives: It is still under debate that red blood cell (RBC) transfusions might increase the risk of healthcare-associated infections after hip fracture surgery. Previously, we found that a liberal RBC transfusion strategy improved survival in nursing home residents. Our aim, therefore, was to investigate whether a more liberal RBC transfusion strategy was associated with a higher infection risk in frail elderly hip fracture patients. Design: Prospective, assessor-blinded, randomized and controlled trial. Settings: Orthopedic ward, Geriatric ward, and Hospital-at-home. Patients: 284 consecutively hospital-admitted elderly with hip fracture from nursing homes or sheltered housing facilities were included. Intervention: A restrictive RBC transfusion strategy (hemoglobin <9.7 g/dL; 6 mmol/L) compared with a liberal strategy (hemoglobin <11.3 g/dL; 7 mmol/L) administered within 30 days after surgery. Main outcome measurements: Leukocytes and C-reactive protein (CRP) in repeated blood samples within 30 days, and number of all infections (pneumonia, urinary tract infection, and other infections) within 10 days. Results: 88 % of the patients received a RBC transfusion. A median of 1 RBC unit (interquartile range (IQR): 1–2) was transfused for the restrictive strategy group versus 3 RBC units (IQR: 2–5) for the liberal group. Leukocytes and CRP measurements were similar for both groups. Rates of infection were 72 % for the restrictive group compared to 66 % for the liberal group (risk ratio 1.08; 95 % confidence interval 0.93–1.27, p value 0.29). Conclusions: A more liberal RBC transfusion strategy was not associated with higher risk of infection among residents from nursing homes or sheltered housing undergoing hip fracture surgery. © 2015, Springer-Verlag France.
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页码：1031 / 1038
页数：7
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