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Perioperative transfusion threshold and ambulation after hip revision surgery – a randomized trial

机译：髋关节翻修手术后的围手术期输血阈值和下床活动–一项随机试验

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Background Transfusion with red blood cells (RBC) may be needed during hip revision surgery but the appropriate haemoglobin concentration (Hb) threshold for transfusion has not been well established. We hypothesized that a higher transfusion threshold would improve ambulation after hip revision surgery. Methods The trial was registered at Clinicaltrials.gov ( NCT00906295 ). Sixty-six patients aged 18?years or older undergoing hip revision surgery were randomized to receive RBC at a Hb threshold of either 7.3?g/dL (restrictive group) or 8.9?g/dL (liberal group). Postoperative ambulation was assessed using Timed Up and Go-test (TUG) and ability to walk was also assessed daily by a physiotherapist blinded to the allocation. Results Fifty-three patients were able to perform the TUG and included in the analysis. The TUG could be completed in a median of 36?sec vs. 30?sec in the restrictive group and the liberal group, respectively (P?=?0.02). The mean difference in TUG was 14.5?sec (95% CI 2.8-26.2?sec). No difference was found in the day patients could perform TUG or walk 10 meters. The Hb at the day of testing was 10.2?g/dL in the restrictive group and 9.9?g/dL in the liberal group. Only 26 patients received RBC. Conclusions A Hb transfusion threshold of 8.9?g/dL was associated with a statistically significantly faster TUG after hip revision surgery compared to a threshold of 7.3?g/dL but the clinical importance is questionable and the groups did not differ in Hb at the time of testing.
机译：背景技术在髋关节翻修手术中可能需要使用红细胞（RBC）进行输血，但尚未很好地确定适当的输血血红蛋白浓度（Hb）阈值。我们假设较高的输血阈值将改善髋关节翻修手术后的下肢活动。方法该试验已在Clinicaltrials.gov（NCT00906295）上进行了注册。接受髋关节翻修手术的16岁18岁或以上的患者被随机分配接受Hb阈值为7.3？g / dL（限制组）或8.9？g / dL（自由组）的RBC。使用定时和Go-test（TUG）评估术后移动，并且每天由不知情分配的物理治疗师评估步行能力。结果53例患者能够进行TUG并纳入分析。在限制组和自由组中，TUG的平均完成时间为36秒，而中位组为30秒（P = 0.02）。 TUG的平均差异为14.5微秒（95％CI 2.8-26.2微秒）。患者可以进行TUG或步行10米的当天没有发现差异。测试当天的血红蛋白水平在限制组为10.2？g / dL，在自由组为9.9？g / dL。仅26例患者接受了RBC。结论Hb输注阈值为8.9？g / dL与髋关节翻修手术后的TUG在统计学上显着相关，而阈值为7.3？g / dL，但临床意义值得怀疑，当时两组的Hb并无差异测试。

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