The Effect Of Different Blood Transfusion Strategies Onprognosis And Outcome Inpatientswith Hip Fracture:A Systematic Review And Meta-analysis

Objective To systematically evaluate whether the restrictive transfusion strategy was not inferior to a liberal strategy in hip fracture patients.Methods MEDLINE, EMBASE, Web of Science Core Collection and The Cochrane Library were searched to identify randomized trails that compared the restrictive and liberal blood transfusion strategy in hip fracture patients. The year considered was from 1946 to March Week 3 2015 for it was available in the database. The Reference lists of relevant articles identified by database searching were searched for additional studies. Two investigators independently selected studies, assessed risk of bias of individual studies and extracted data from the studies. Studies were excluded if they were animal studies, non-randomized controlled trials, did not report functional rehabilitation, mortality, in-hospital complications, length of hospital stay as clinical outcomes. The Rev Man 5.3 was used to pool the data extracted from studies.Results Six studies with a total of 2704 participants met inclusion criteria, of which five studies were eligible for meta-analysis. Pooled results showed that the restrictive strategy resulted in some similar clinical outcomes, including inability to walk independently at 60-day(RR, 1.0; 95% CI, 0.87-1.14), 30-day mortality(RR, 1.09; 95% CI, 0.79-1.50), 60-day mortality(RR, 0.91; 95% CI, 0.67-1.24), cardiac events(RR, 1.22; 95% CI, 0.97-1.53), cerebrovascular accident(RR, 0.42; 95% CI, 0.15-1.18), thromboembolism(RR, 0.87; 95% CI, 0.42-1.80), delirium(RR, 0.76; 95% CI, 0.29-2.05), length of hospital stay(SMD, 0.06; 95% CI,-0.12- 0.14), compared with the liberal strategy. The incidence of in-hospital infection decreased with a restrictive strategy(RR, 0.69; 95% CI, 0.52-0.92).The number of patients transfused and the number of units decreased with a restrictive strategy(each P<0.05).Conclusion The effect of the restrictive transfusion strategy in hip fracture patients on functional rehabilitation, mortality, cardiac events,cerebrovascular accident, thromboembolism,delirium,and length of hospital stay is not inferior to the liberal strategy. The restrictive strategy can reduce risk of in-hospital infection in hip fracture patients, and blood can be saved by the restrictive transfusion strategy.