Perioperative transfusion threshold and ambulation after hip revision surgery – a randomized trialReport as inadecuate




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BMC Anesthesiology

, 14:89

Perioperative medicine and outcome

Abstract

BackgroundTransfusion 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.

MethodsThe 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.

ResultsFifty-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.

ConclusionsA 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.

KeywordsTransfusion threshold Haemoglobin concentration Red blood cells Ambulation Hip surgery AbbreviationsBPBlood pressure

FFPFresh frozen plasma

HbHaemoglobin concentration

LIALocal infiltration analgesia

MAPMean arterial pressure

PACUPostoperative care unit

PCAPatient controlled analgesia

RBCRed blood cells

TUGTimed up and go-test

VASVisual analogue scale.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2253-14-89 contains supplementary material, which is available to authorized users.

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