2023 OTA Annual Meeting : Liberal Transfusion Causes Higher Infection Rates With No Benefit to Functional Outcomes, Orthopaedic Trauma, and Anemia: Conservative Versus Liberal Transfusion (ORACL): A Prospective Randomized Study

100 orthopaedic trauma patients were randomized to receive a blood transfusion strategy with a conservative anemic threshold (5.5 g/dL) or a liberal threshold (7.0 g/dL). The outcomes of interest included the incidence of infection (deep, superficial, overall), complications, and the Musculoskeletal Functional Assessment (MFA) measured at 6 months and 1 year follow-up. The results showed that a conservative strategy significantly reduced the rate of infection compared to a liberal strategy (p=0.01). In particular, the rate of superficial infection was significantly lower in the conservative group (7% vs. 0%, p<0.01); the rate of deep infection was lower in the conservative group as well, but this difference was not significantly different due to the lack of power (14% vs. 6%, p=0.2). No differences in the rate of complications or MFA scores were observed between the two groups.