Restrictive blood transfusion strategies and associated infection in orthopedic patients: a meta-analysis of 8 randomized controlled trials.

Zhaowei Teng,Yugang Liu,Shuangneng Wang,Guojun Wei,Xiguang Zhang,Yun Zhu,Shaoliang Du

doi:10.1038/srep13421

Abstract

This study sought to evaluate whether restrictive blood transfusion strategies are associated with a risk of infection in orthopedic patients by conducting a meta-analysis of randomized controlled trials (RCTs). RCTs with restrictive versus liberal red blood cell (RBC) transfusion strategies were identified by searching Medline, Embase, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews from their inception to December 2014. Eight RCTs with infections as outcomes were included in the final analysis. According to the Jadad scale, all studies were considered to be of high quality. The pooled risk ratio [RR] for the association between transfusion strategy and infection was 0.65 (95% CI, 0.47–0.91; p = 0.012), and the number of patients needed to treat to avoid an infection using a restrictive transfusion strategy was 62. No heterogeneity was observed. The sensitivity analysis indicated unstable results, and no significant publication bias was observed. This meta-analysis of RCTs demonstrates that restrictive transfusion strategies in orthopedic patients result in a significant reduction in infections compared with more liberal strategies.

Highlights

IntroductionAdditional scientific evidence has subsequently been published, in patients undergoing orthopedic surgery
We identified 429 potential citations (128 from Medline; 130 from Embase; 100 from the Cochrane Central Register of Controlled Trials Databases; 6 from the Cochrane Database of Systematic Reviews and 65 from Journals@Ovid Full Text) for studies comparing a restrictive blood transfusion strategy and a liberal transfusion strategy for the treatment of orthopedic patients
The number needed to treat (NNT) with a restrictive transfusion strategy to prevent all infections was 62, and the number of avoided infections per 1,000 patients was 16.13. This meta-analysis of randomized controlled trials (RCTs) was performed to describe the infection risk following restrictive red blood cells (RBCs) transfusion strategies compared to liberal RBC transfusion strategies in orthopedic patients

Summary

Introduction

Additional scientific evidence has subsequently been published, in patients undergoing orthopedic surgery. It remains controversial whether restrictive blood transfusion strategies versus liberal blood transfusion strategies may reduce infectious events. Restrictive blood transfusion strategies are widely used for older patients undergoing orthopedic surgery. To our knowledge, no specific meta-analysis of the association between infection risk and restrictive blood transfusion strategies has been conducted to date. We performed a meta-analysis with the purpose of assessing the infection risk among orthopedic patients who had been subjected to restrictive transfusion strategies

Methods

Results

Conclusion