RESULT-Hip. The impact of restrictive compared with liberal transfusion strategy on cardiac injury and death in patients undergoing surgery for hip fracture

Aims Hip fracture is a global health issue. Complications are common, leading to reduced quality of life or death. These occur more frequently if anaemia is present. We hypothesize that correcting anaemia in the perioperative period may decrease major adverse cardiac events (MACE) and death after hip fracture. Methods This multicentre prospective randomized trial compares transfusion strategies after hip fracture in patients aged ≥ 60 years. We initially planned to randomize 1,984 participants with anaemia, defined as haemoglobin ≤ 90 g l -1 , to one of two transfusion strategies: liberal transfusion (aim haemoglobin 90 g l -1 to 110 g l -1 ), or restrictive transfusion (aim 75 g l -1 to 90 g l -1 ). The intervention lasts from randomization to hospital discharge or 30 days post randomization, whichever is soonest. The primary outcome measure was a composite of death or MACE adjudicated by blinded clinical experts. Secondary outcomes included all-cause mortality and quality of life, evaluated at 120 days. Cost-effectiveness and health economic evaluation will also be reported. Results This trial was funded by the National Institute for Health and Care Research, HTA award (National Institute for Health and Care Research (NIHR) 130875) and registered at ISRCTN 28818784. Ethical approval was obtained to recruit patients in the UK. As recruitment fell short of the initial target, and following consultation with the funder, we refined our primary outcome to include myocardial injury after non-cardiac surgery (MINS), and reduced the required sample size to 842. Conclusion Recruitment commenced on 10 June 2022. The first participant was recruited on 16 June 2022. We will engage clinicians and healthcare planners to implement the findings. We plan to recruit until 31 October 2026. Results will be disseminated to clinicians, policymakers, patients, and the public. Cite this article: Bone Jt Open 2026;7(10):1342–1351.