Effect of Restrictive Blood Transfusion Strategy on Perioperative Prognosis in Elderly Orthopedic Surgery Patients With Preoperative Anemia.

Abstract

Aim: Preoperative anemia remains a common condition in elderly patients undergoing orthopedic surgery, and the choice of transfusion strategy may affect perioperative outcomes. Therefore, this study aims to investigate the effect of a restrictive transfusion strategy on perioperative outcomes in this population.

Methods: A retrospective analysis was conducted on 782 preoperatively anemic patients (aged ≥60 years) who underwent hip replacement, knee replacement, or spine surgery at Xuanwu Hospital Capital Medical University, China, between January 2018 and June 2024. Patients were categorized into the restrictive (n = 380) and liberal (n = 402) transfusion strategy groups. Perioperative indicators included estimated blood loss, transfusion volume, length of hospital stay, as well as additional relevant variables. Primary outcomes were 30-day all-cause mortality, transfusion-related adverse reactions, and postoperative infection rates. Secondary outcomes included postoperative hemoglobin levels, readmission rates, reoperation rates, thrombosis, and cardiovascular events.

Results: In hip replacement and spine surgery patients, the estimated blood loss was significantly lower in the restrictive transfusion group than in the liberal transfusion group (p < 0.001), while higher in knee replacement patients (p < 0.001). The restrictive transfusion strategy reduced transfusion requirements and shortened hospital stay across all surgical types (p < 0.001). No significant difference in 30-day all-cause mortality was observed between the groups (p > 0.05). However, the restrictive transfusion group had significantly lower rates of transfusion-related adverse reactions (1.3% vs. 5.0%, p < 0.001) and infections (2.6% vs. 6.5%, p = 0.017). Additionally, transfusion strategy was identified as an independent risk factor for transfusion-related adverse reactions [odds ratio (OR) = 3.96, 95% CI: 1.468-10.682, p = 0.007)].

Conclusions: A restrictive transfusion strategy reduces transfusion volume, minimizes the incidence of transfusion-related adverse reactions and infections. This study supports individualized perioperative anemia management to optimize outcomes in elderly patients.