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

  • Original Article • HIP - FRACTURES
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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

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.

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Acknowledgments

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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Authors and Affiliations

  1. Department of Geriatrics, Aarhus University Hospital, P.P. Oerumsgade 11, 8000, Århus C, Denmark

    Merete Gregersen & Else Marie Damsgaard

  2. Department of Orthopaedics, Aarhus University Hospital, Nørrebrogade 44, 8000, Århus C, Denmark

    Lars Carl Borris

Authors
  1. Merete Gregersen
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  2. Else Marie Damsgaard
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  3. Lars Carl Borris
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Correspondence to Merete Gregersen.

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Gregersen, M., Damsgaard, E.M. & Borris, L.C. Blood transfusion and risk of infection in frail elderly after hip fracture surgery: the TRIFE randomized controlled trial. Eur J Orthop Surg Traumatol 25, 1031–1038 (2015). https://doi.org/10.1007/s00590-015-1609-2

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  • DOI: https://doi.org/10.1007/s00590-015-1609-2

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