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Orthopaedic Trauma and Anemia: Conservative versus Liberal Transfusion Strategy: A Prospective Randomized Study

J Orthop Trauma. 2024 Jan 1;38(1):18-24 doi: 10.1097/BOT.0000000000002696.
PICO Summary
POPULATION:

Musculoskeletal trauma patients with planned surgery (n= 99).

INTERVENTION:

Liberal transfusion threshold of 7.0 g/dL (n= 49).

COMPARISON:

Conservative transfusion threshold of 5.5 g/dL (n= 50).

OUTCOME:

Overall, 46/49 (93.9%) of the liberal group had a transfusion versus 23/50 (46.0%) of the conservative group had a transfusion after resuscitation and after enrollment in this study. Following resuscitation and enrollment in the study, patients in the liberal group received a median of 1 unit of blood transfused (range 0–12) and patients in the conservative group received a median of 0 units of blood (range 0–14). Sixty-five patients completed 1- year follow-up. There was a significant association between a liberal transfusion strategy and higher rate of infection, with no difference in functional outcomes at 6 months or 1 year.

Abstract
OBJECTIVES:

To determine whether it is safe to use a conservative packed red blood cell transfusion hemoglobin (Hgb) threshold (5.5 g/dL) compared with a liberal transfusion threshold (7.0 g/dL) for asymptomatic musculoskeletal injured trauma patients who are no longer in the initial resuscitative period.

METHODS:

Design: Prospective, randomized, multicenter trial.

SETTING:

Three level 1 trauma centers.

PATIENT SELECTION CRITERIA:

Patients aged 18-50 with an associated musculoskeletal injury with Hgb less than 9 g/dL or expected drop below 9 g/dL with planned surgery who were stable and no longer being actively resuscitated were randomized once their Hgb dropped below 7 g/dL to a conservative transfusion threshold of 5.5 g/dL versus a liberal threshold of 7.0 g/dL.

OUTCOME MEASURES AND COMPARISONS:

Postoperative infection, other post-operative complications and Musculoskeletal Functional Assessment scores obtained at baseline, 6 months, and 1 year were compared for liberal and conservative transfusion thresholds.

RESULTS:

Sixty-five patients completed 1 year follow-up. There was a significant association between a liberal transfusion strategy and higher rate of infection (P = 0.01), with no difference in functional outcomes at 6 months or 1 year. This study was adequately powered at 92% to detect a difference in superficial infection (7% for liberal group, 0% for conservative, P < 0.01) but underpowered to detect a difference for deep infection (14% for liberal group, 6% for conservative group, P = 0.2).

CONCLUSIONS:

A conservative transfusion threshold of 5.5 g/dL in an asymptomatic young trauma patient with associated musculoskeletal injuries leads to a lower infection rate without an increase in adverse outcomes and no difference in functional outcomes at 6 months or 1 year.

LEVEL OF EVIDENCE:

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Metadata
MESH HEADINGS: Humans; Prospective Studies; Orthopedics; Anemia; Hemoglobins; Blood Transfusion; Postoperative Complications
Study Details
Study Design: Randomised Controlled Trial
Language: eng
Credits: Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine