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

  • Merete Gregersen
  • Else Marie Damsgaard
  • Lars Carl Borris
Original Article • HIP - FRACTURES



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.


Prospective, assessor-blinded, randomized and controlled trial.


Orthopedic ward, Geriatric ward, and Hospital-at-home.


284 consecutively hospital-admitted elderly with hip fracture from nursing homes or sheltered housing facilities were included.


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.


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).


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.


Infection Hip fracture Frail elderly Blood transfusion 



We gratefully acknowledge the kind participation of patients, their relatives, and their general practitioner. We would also like to thank the contributions to this study of our colleagues at the Orthopedic ward and the Geriatric Ward, especially the Orthogeriatric Team. We have received grants from the Helga and Peter Korning Foundation for medical equipment (HemoCue portable photometer). Costs of data collection, analyses, and article writing were borne by the Department of Geriatrics at Aarhus University Hospital.

Conflict of interest

The authors declare that there is no conflict of interest.


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Copyright information

© Springer-Verlag France 2015

Authors and Affiliations

  • Merete Gregersen
    • 1
  • Else Marie Damsgaard
    • 1
  • Lars Carl Borris
    • 2
  1. 1.Department of GeriatricsAarhus University HospitalÅrhus CDenmark
  2. 2.Department of OrthopaedicsAarhus University HospitalÅrhus CDenmark

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