Fewer patients need blood transfusion after surgery than is widely believed. A recent study found no ill effects from postponing transfusion until patients develop signs of anemia or their hemoglobin concentration falls below 8 g/dL.

The results likely will reduce the number of blood transfusions—and costs—substantially. The study was published online on December 14, 2011, in the New England Journal of Medicine.

More than 2,000 hip fracture patients with risk factors for heart disease were divided into two groups, either liberal transfusions or restrictive. Recovery, risk of heart attack, death, and other outcomes were similar, regardless of the transfusion.

“This study will help resolve the debate about how much blood patients need after surgery. Very often, a blood transfusion isn’t necessary, even for frail elderly patients,” says William Macaulay, MD, a member of the study’s steering committee.

NewYork-Presbyterian Hospital/Columbia University Medical Center was one of 47 centers participating in the FOCUS (Transfusion Trigger Trial for Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture Repair) study, sponsored by the National Heart, Lung, and Blood Institute, NIH, and led by the UMDNJ-Robert Wood Johnson Medical School with Jeff Carson, MD, the Richard C. Reynolds Professor of Medicine, as the Principal Investigator.

“Since Medicare pays for about 300,000 hip fracture surgeries per year, and this restrictive transfusion approach may be appropriate in many other clinical scenarios,” Macaulay said, “the cost savings of giving fewer transfusions could be enormous.”

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