Less blood needed after hip fracture surgery

Patients may need less blood than previously believed following operative hip fracture repair, according to a study published in the New England Journal of Medicine. The study found no ill effects occurred when transfusion was postponed until patients developed signs of anemia after surgery or until hemoglobin concentration dropped to less than 8 g/dL.

“As the medical community further embraces a restrictive approach to post-surgery blood transfusion, it’s important that physicians carefully evaluate patients for symptoms of anemia and not just rely onhemoglobin levels,” researcher William Macaulay, MD , stated in a Columbia University Medical Center news release. “The patient’s body will often tell us when it needs blood.”

The study followed 2,016 patients aged 50 years or older who underwent surgery for hip fractures and also displayed a history of risk factors for cardiovascular disease. Patients were randomized into two groups: a liberal group who received transfusion when their hemoglobin level fell to less than 10 g/dL and a restrictive group who received transfusions when they displayed symptoms of anemia or at a physician’s discretion should the patient’s hemoglobin fall to less than 8 g/dL.


he researchers found similar rates of primary outcome – noted in the study as death or inability to walk across a room without human assistance at 60-day follow-up – between the two groups. Similar results were also found between the two groups for risk of death within 60 days, functional recovery, heart attack risk, infection and falls.

According to the release, patients in the restrictive group received 65% fewer units of blood than the liberal group – with 58.5% of patients in the restrictive group not receiving any blood transfusion.


Carson JL, Terrin ML, Noveck H, et al. Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med. 2011. doi: 10.1056/NEJMoa1012452

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Josh Sandberg

Josh Sandberg is the President of Ortho Spine Partners and Partner for The De Angelis Group. He also serves as Co-Founder and Editor of OrthoSpineNews.

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