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To the Editor.—The study by Dr Carson and colleagues¹ addresses a crucial issue in perioperative transfusion policy, as older subjects with hip fracture currently require a major proportion of the blood units administered to surgical patients. The authors conclude that perioperative transfusions in patients with hemoglobin levels between 80 and 100 g/L do not yield any survival benefit. However, the risk-benefit ratio of transfusions in these subjects may be even worse than suggested by their study.

In an ongoing study on transfusion requirements in older patients with hip fracture,² we analyzed the 60-day survival in 206 consecutive older patients (mean [SD] age, 80 [7] years). Using a transfusion trigger set to a minimum hemoglobin level of 95 g/L,³ death occurred in 22 of 106 patients who received allogenic blood and in 3 of 100 who did not receive transfusions (Fisher exact test, P<.001). In Cox regression analysis, administration . . . [Full Text of this Article]

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JAMA. 1998;279(3):199-205.
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