Abstract: Objective Hip fracture （HF） in frail elderly patients is associated with poor physical recovery and death. Postoperative blood loss is frequently seen and the volume of red blood cell （RBC） transfusions is unknown in the patients. Method We investigated the association of RBC transfusion strategies with the degree of physical recovery or with reduced mortality after HF surgery. We collected 115 consecutive postsurgical HF patients （age≥65 years） with Hb levels<113 g/L in the hospital. Allocation was stratified by residence. The patients were randomLy assigned to either restrictive （Hb<97 g/L） or liberal （Hb<113 g/L） RBC transfusions given within the first 30 days postoperatively. Follow-up was performed for 90 days. Results Statistically significant differences were found in repeated measures of daily living activities or in 90-day mortality rate between the restrictive group （30% died） and the liberal group （16% died）. Thirty-day mortality was higher with the restrictive strategy （hazard ratio （HR） =1.7 95%CI 0.6-3.4; P=0.02） compared with that with liberal transfusion. The 90-day mortality rate was higher for patients in the restrictive transfusion group （36%） than for those in the liberal group （20%） （HR =1.5 95%CI 0.8-2.1;P=0.03）. Conclusion According to our Hb thresholds,recovery from physical disabilities in the patients with frail elderly hip fracture varied following restrictive RBC transfusion strategy and liberal strategy. Implementation of a liberal RBC transfusion strategy in nursing home residents has the potential in increasing survival.

Key words: Hip, fracture, Btransfusion, Elderly, patients