***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: BACKGROUND Peri-operative red blood cell transfusions have been associated with post-operative complications in patients undergoing elective orthopaedic hip or knee replacement surgery . MATERIAL S AND METHODS We performed a post-hoc analysis of data extracted from a r and omised study on transfusion triggers using pre-storage leucocyte-depleted red blood cells . Patients who were assigned to the most restrictive transfusion policy ( " restrictive group " ) were compared with patients who were assigned to the most liberal policy ( " liberal group " ) . End-points were red blood cell use , hospital stay , haemoglobin levels , post-operative complications and quality of life scores . RESULTS Of 603 patients , 26.4 % patients in the restrictive group and 39.1 % in the liberal group were transfused ( P = 0.001 ) . The rate of post-operative infections was lower , although not statistically significantly so , in the restrictive group than in the liberal group ( 5.4 % vs. 10.2 % , respectively ) as was the rate of respiratory complications ( 1.7 % vs. 4.9 % , respectively ) , whereas hospital stay , cardiovascular complications and mortality rate were not different in the two groups . Quality of life scores were not associated with type of transfusion policy , the number of red blood cell transfusions or the transfusion status . DISCUSSION A restrictive transfusion protocol was not associated with worse outcome and result ed in a lower transfusion rate compared to the liberal policy . Well-being ( quality of life ) was not associated with transfusion policy or with red blood cell transfusions Background and purpose — Hip fracture ( HF ) in frail elderly patients is associated with poor physical recovery and death . There is often postoperative blood loss and the hemoglobin ( Hb ) threshold for red blood cell ( RBC ) transfusions in these patients is unknown . We investigated whether RBC transfusion strategies were associated with the degree of physical recovery or with reduced mortality after HF surgery . Patients and methods — We enrolled 284 consecutive post-surgical HF patients ( aged ≥ 65 years ) with Hb levels < 11.3 g/dL ( 7 mmol/L ) who had been admitted from nursing homes or sheltered housing . Allocation was stratified by residence . The patients were r and omly assigned to either restrictive ( Hb < 9.7 g/dL ; < 6 mmol/L ) or liberal ( Hb < 11.3 g/dL ; < 7 mmol/L ) RBC transfusions given within the first 30 days postoperatively . Follow-up was at 90 days . Results — No statistically significant differences were found in repeated measures of daily living activities or in 90-day mortality rate between the restrictive group ( where 27 % died ) and the liberal group ( where 21 % died ) . Per- protocol 30-day mortality was higher with the restrictive strategy ( hazard ratio ( HR ) = 2.4 , 95 % CI : 1.1–5.2 ; p = 0.03 ) . The 90-day mortality rate was higher for nursing home residents in the restrictive transfusion group ( 36 % ) than for those in the liberal group ( 20 % ) ( HR = 2.0 , 95 % CI : 1.1–3.6 ; p = 0.01 ) . Interpretation — According to our Hb thresholds , recovery from physical disabilities in frail elderly hip fracture patients was similar after a restrictive RBC transfusion strategy and after a liberal strategy . Implementation of a liberal RBC transfusion strategy in nursing home residents has the potential to increase survival Objectives It is still under debate that red blood cell ( RBC ) transfusions might increase the risk of healthcare-associated infections  after hip fracture surgery . Previously , we found that a liberal RBC transfusion strategy improved survival in nursing home residents . Our aim , therefore , was to investigate whether a more liberal RBC transfusion strategy was associated with a higher infection risk in frail elderly hip fracture patients . Design Prospect i ve , assessor-blinded , r and omized and controlled trial . Setting sOrthopedic ward , Geriatric ward , and Hospital-at-home . Patients 284 consecutively hospital-admitted elderly with hip fracture from nursing homes or sheltered housing facilities were included . InterventionA restrictive RBC transfusion strategy ( hemoglobin < 9.7 g/dL ; 6 mmol/L ) compared with a liberal strategy ( hemoglobin < 11.3 g/dL ; 7 mmol/L ) administered within 30 days after surgery . Main outcome measurements Leukocytes and C-reactive protein ( CRP ) in repeated blood sample s within 30 days , and number of all infections ( pneumonia , urinary tract infection , and other infections ) within 10 days . Results 88 % of the patients received a  RBC transfusion .  A median of 1 RBC unit ( interquartile range ( IQR ) : 1–2 ) was transfused for the restrictive strategy group versus 3 RBC units ( IQR : 2–5 ) for the liberal group . Leukocytes and CRP measurements were similar for both groups . Rates of infection were 72 % for the restrictive group compared to 66 % for the liberal group ( risk ratio 1.08 ; 95 % confidence interval 0.93–1.27 , p value 0.29 ) . Conclusions A more liberal RBC transfusion strategy was not associated with higher risk of infection among residents from nursing homes or sheltered housing undergoing hip fracture surgery BACKGROUND The hemoglobin threshold at which postoperative red-cell transfusion is warranted is controversial . We conducted a r and omized trial to determine whether a higher threshold for blood transfusion would improve recovery in patients who had undergone surgery for hip fracture . METHODS We enrolled 2016 patients who were 50 years of age or older , who had either a history of or risk factors for cardiovascular disease , and whose hemoglobin level was below 10 g per deciliter after hip-fracture surgery . We r and omly assigned patients to a liberal transfusion strategy ( a hemoglobin threshold of 10 g per deciliter ) or a restrictive transfusion strategy ( symptoms of anemia or at physician discretion for a hemoglobin level of < 8 g per deciliter ) . The primary outcome was death or an inability to walk across a room without human assistance on 60-day follow-up . RESULTS A median of 2 units of red cells were transfused in the liberal- strategy group and none in the restrictive- strategy group . The rates of the primary outcome were 35.2 % in the liberal- strategy group and 34.7 % in the restrictive- strategy group ( odds ratio in the liberal- strategy group , 1.01 ; 95 % confidence interval [ CI ] , 0.84 to 1.22 ) , for an absolute risk difference of 0.5 percentage points ( 95 % CI , -3.7 to 4.7 ) . The rates of in-hospital acute coronary syndrome or death were 4.3 % and 5.2 % , respectively ( absolute risk difference , -0.9 % ; 99 % CI , -3.3 to 1.6 ) , and rates of death on 60-day follow-up were 7.6 % and 6.6 % , respectively ( absolute risk difference , 1.0 % ; 99 % CI , -1.9 to 4.0 ) . The rates of other complications were similar in the two groups . CONCLUSIONS A liberal transfusion strategy , as compared with a restrictive strategy , did not reduce rates of death or inability to walk independently on 60-day follow-up or reduce in-hospital morbidity in elderly patients at high cardiovascular risk . ( Funded by the National Heart , Lung , and Blood Institute ; FOCUS Clinical Trials.gov number , NCT00071032 . ) Objectives To investigate whether a liberal blood transfusion strategy [ Hb levels ≥11.3 g/dL ( 7 mmol/L ) ] reduces the risk of postoperative delirium ( POD ) on day 10 , among nursing home residents with hip fracture , compared to a restrictive transfusion strategy [ Hb levels ≥9.7 g/dL ( 6 mmol/L ) ] . Furthermore , to investigate whether POD influences mortality within 90 days after hip surgery . Methods This is a post hoc analysis based on The TRIFE - a r and omized controlled trial . Frail anemic patients from the Orthopedic Surgical Ward at Aarhus University Hospital were enrolled consecutively between January 18 , 2010 and June 6 , 2013 . These patients ( aged ≥65 years ) had been admitted from nursing homes for unilateral hip fracture surgery . After surgery , 179 patients were included in this study . On the first day of hospitalization , all enrolled patients were examined for cognitive impairment ( assessed by MMSE ) and delirium ( assessed by CAM ) . Delirium was also assessed on the tenth postoperative day . Results The prevalence of delirium was 10 % in patients allocated to a liberal blood transfusion strategy ( LB ) and 21 % in the group with a restrictive blood transfusion strategy ( RB ) . LB prevents development of delirium on day 10 , compared to RB , odds ratio 0.41 ( 95 % CI 0.17–0.96 ) , p = 0.04 . Development of POD on day 10 increased the risk of 90-day death , hazard ratio 3.14 ( 95 % CI 1.72–5.78 ) , p < 0.001 . Conclusion In nursing home residents undergoing surgery for hip fracture , maintaining hemoglobin level above 11.3 g/dL reduces the rate of POD on day 10 compared to a RB . Development of POD is associated with increased mortality BACKGROUND To determine whether a restrictive strategy of red-cell transfusion and a liberal strategy produced equivalent results in critically ill patients , we compared the rates of death from all causes at 30 days and the severity of organ dysfunction . METHODS We enrolled 838 critically ill patients with euvolemia after initial treatment who had hemoglobin concentrations of less than 9.0 g per deciliter within 72 hours after admission to the intensive care unit and r and omly assigned 418 patients to a restrictive strategy of transfusion  , in which red cells were transfused if the hemoglobin concentration dropped below 7.0 g per deciliter and hemoglobin concentrations were maintained at 7.0 to 9.0 g per deciliter , and 420 patients to a liberal strategy  , in which transfusions were given when the hemoglobin concentration fell below 10.0 g per deciliter and hemoglobin concentrations were maintained at 10.0 to 12.0 g per deciliter . RESULTS Overall , 30-day mortality was similar in the two groups ( 18.7 percent vs. 23.3 percent , P= 0.11 ) . However , the rates were significantly lower with the restrictive transfusion strategy among patients who were less acutely ill -- those with an Acute Physiology and Chronic Health Evaluation II score of < or = 20 ( 8.7 percent in the restrictive- strategy group and 16.1 percent in the liberal- strategy group ; P=0.03 ) -- and among patients who were less than 55 years of age ( 5.7 percent and 13.0 percent , respectively ; P=0.02 ) , but not among patients with clinical ly significant cardiac disease ( 20.5 percent and 22.9 percent , respectively ; P=0.69 ) . The mortality rate during hospitalization was significantly lower in the restrictive- strategy group ( 22.3 percent vs. 28.1 percent , P=0.05 ) . CONCLUSIONS A restrictive strategy of red-cell transfusion is at least as effective as and possibly superior to a liberal transfusion strategy in critically ill patients , with the possible exception of patients with acute myocardial infa rct ion and unstable angina BACKGROUND A before and after study was undertaken to investigate the effect of universal leukoreduction ( ULR ) in the UK on postoperative length of hospital stay ( LOS ) and infections . STUDY DESIGN AND METHODS Consecutive patients undergoing elective coronary artery bypass grafting or total hip and /or knee replacement in 11 hospitals  received non-WBC-reduced RBCs before implementation of ULR ( T1 , n=997 ) or WBC-reduced RBCs after implementation of ULR ( T2 , n=1098 ) . RESULTS Patients in T1 and T2 were comparable except patients in T2 received on average more units of RBCs but had lower discharge Hct levels . Postoperative LOS ( T1 , 10 + /- 8.9 days ; T2 , 9.6 + /- 6.9 days ) and the proportion of patients with suspected and proven postoperative infections ( T1 , 21.0 % ; T2 , 20.0 % ) were unchanged before and after ULR ( LOS , hazard ratio 1.01 , 95 % CI 0.92 - 1.10 ; infections , OR 0.83 , 95 % CI 0.77 - 1.02 ) . Subgroup analysis showed no significant interaction between storage age or dose of blood on responsiveness of primary outcomes to ULR . Secondary outcomes were unchanged overall . Analysis by surgical procedure gave conflicting results with both increased mortality ( p=0.031 ) and an increased proportion of cardiac patients with proven infections ( p=0.004 ) , whereas the proportion of orthopedic patients with proven infections was reduced ( p=0. 
    Output:
    
INTERPRETATION Liberal transfusion strategies might produce better outcomes in geriatric patients  than restrictive transfusion strategies .
This outcome contradicts current restrictive transfusion approaches .