Mortality and Functional Outcomes of Liberal versus Restrictive Blood Transfusion in Elderly Patients after Hip Surgery: A Randomised Control Trial.

Purpose: There is ongoing debate on the haemoglobin level at which red cell transfusion should be administered following surgery. This study aimed to evaluate the benefits of a restrictive blood transfusion strategy and assess potential adverse effects of anaemia in the immediate postoperative phase, determining whether a liberal transfusion approach still remains necessary. Materials and Methods: A randomized control trial compared two groups: Group 1, with a liberal blood transfusion strategy, and Group 2, with a restrictive blood transfusion protocol. Haemoglobin levels were measured on the 3rd and 12th postoperative days, and at 1-month follow-up. Clinical and functional evaluations were conducted at the 1-month follow-up. Results: There was no significant difference between the liberal and restrictive groups in 10 feet walking with support at 12 days and at 1 month. The restrictive group had a shorter hospital stay (17.57±4.66 days) compared to the liberal group (19.56±5.34 days). Incidence of surgical site infections were similar (4.0% in liberal, 2.0% in restrictive), and no mortalities were observed in either group at the 1-month follow-up. Conclusion: Both liberal and restrictive transfusion strategies were similarly effective in terms of early postoperative mortality and functional mobility. However, patients in the liberal transfusion group had a significantly longer length of stay compared to the restrictive group. Leading us to conclude that a restrictive strategy is effective and beneficial for patients and hospitals provided there are no signs of anaemia or a haemoglobin drop below 8 g/dL.