Please select the eligibility criteria that correspond to the clinical trial below.
Title: CSP #599 - Transfusion Trigger After Operations in High Cardiac Risk Patients (TOP)
Brief Summary: The goal of the proposed study is to determine whether a liberal transfusion strategy (transfusion trigger at Hb \< 10 gm/dl) in Veterans at high cardiac risk who undergo major open vascular and general surgery operations is associated with decreased risk of adverse postoperative outcomes compared to a restrictive transfusion strategy (transfusion trigger at Hb \< 7 gm/dl).


Options:
A: Inclusion Criteria:

* Age \> 18 years old
* Anticipated or proven admission to immediate postoperative resuscitation after scheduled or emergency oncology surgery, for the removal of a neoplastic lesion among the following surgical procedures:

  * Visceral surgery: Hepatectomy, duodenopancreatectomy, gastrectomy, esophagectomy, colectomy
  * Urological surgery: Radical prostatectomy, cystectomy, nephrectomy.
  * Gynaecological surgery: Ovariectomy, hysterectomy, mastectomy, pelvectomy
  * Thoracic surgery: Pneumonectomy, lobectomy
  * ENT Surgery: Total laryngectomy, pharyngectomy, glossectomy
  * Spinal surgery: corporectomy wherever it is performed.
* Hemoglobin level \< 9.5 g/dl between the day before surgery (D-1) and discharge from resuscitation at no more than 30 days postoperatively

Exclusion Criteria:

* - Myocardial infarction and/or unstable angina in the 4 weeks prior to surgery
* Refusal to participate in the study
* Minor patient (age \< 18 years)
* Refusal to transfuse red blood cell concentrates (Jehovah's Witness)
* Pregnant or breastfeeding women
* Patients under guardianship or curatorship
B: Inclusion Criteria:

* 18 years or older
* Patients undergoing replacement of hip arthroplasty
* Be legally competent
* Read and understand Danish

Exclusion Criteria:

* Present malignant disease
* Known heart disease with functionality equivalent to NYHA II or CCS II or worse
C: Inclusion Criteria:

* Clinical diagnosis of hip fracture
* Surgery treatment
* Living in nursing homes or sheltered housing facilities
* Haemoglobin level between 6 and 7 mmol/l latest 6th day after surgery
* Written consent

Exclusion Criteria:

* Active cancer
* Pathological fracture
* The patient is against blood transfusion
D: Inclusion Criteria:

* Males and females older than 18 years of age who have postoperative Hb \< 10gm/dl within 15 days after the index operation
* Patients who undergo an operation in either one of the three following categories:

  * Veterans who undergo PAD - related operations including but not limited to the following:

    * aortobifemoral or aortobiiliac bypass
    * open abdominal aortic aneurysm repair with simultaneous repair of aortoiliac occlusive disease
    * visceral bypass
    * iliofemoral bypass
    * femoral bypass or endarterectomy
    * infrainguinal bypass
    * thromboembolectomy
    * supra-aortic trunk bypass or endarterectomy
    * carotid endarterectomy
    * major lower extremity amputations (transfemoral, through the knee, or transtibial)
  * Veterans with past medical history of ischemic stroke or IHD or PAD who undergo the following general surgery procedures, defined as:

    * known prior MI
    * ECG findings consistent with prior MI
    * prior percutaneous coronary intervention
    * prior coronary artery bypass surgery
    * history of angina for which the patient is currently receiving treatment
    * stress test indicating myocardial ischemia
    * who undergo the following General Surgery operations:

      * Open cholecystectomy or other complex biliary reconstruction
      * such as open common bile duct exploration for stones
      * reconstruction as part of oncologic operations such as palliative pancreatic cancer procedures)
    * small bowel resection
    * pancreatectomy
    * colon resection
    * rectal resection
    * splenectomy
    * transhiatal esophagectomy
    * liver resection
    * gastric resection
    * open ventral hernia repair
    * Colostomies (reversals and takedowns)
    * Intestinal anastomosis takedowns and revisions
    * Gastric bypass
    * Adrenalectomies
    * Major diaphragmatic hiatal hernia repairs
  * Veterans with past medical history of ischemic stroke or IHD or PAD who undergo the following Vascular Surgery operations:

    * Open aneurysm repair, including but not limited to:

      * carotid
      * subclavian
      * abdominal aortic
      * iliac
      * femoral
      * popliteal aneurysms
    * and complex endovascular aneurysm repair, defined as:

      * fenestrated endograft
      * or endograft with need for iliac conduit
      * or endovascular aneurysm repair with simultaneous femoral artery reconstruction or bypass
    * Subclavian/vertebral bypasses and transpositions
* Patients undergoing the above procedures will be included in the study regardless of their preoperative Hb level, and regardless of preoperative or intraoperative transfusion they might have received.

Exclusion Criteria:

* Veteran unable to consent
* Veteran unwilling to follow protocol (such as Jehovah's witnesses)
* Veteran with known history of hereditary anemias such as Thalassemia or Sickle cell disease
* Veteran with known history of hereditary bleeding disorders, such as factor VIII or factor IX deficiency
* Veteran with prior history of adverse reaction to blood administration, such as fever, rash, or hemolysis
* Veteran does not speak or understand English
* Veteran hemodynamically unstable or in cardiogenic shock for \>48 hours after the index procedure
* Veteran participating in another interventional trial whose objective is to evaluate the effect of transfusion on outcomes
* Pregnancy in female Veterans
* Veteran is a prisoner or in custody of law enforcement
* Prior randomization in the CSP#599
* Patients who are known to have tested positive for COVID-19 and have not recovered prior to consent will not be consented. Any participant who is known to have a positive COVID-19 test during the screening process and has not recovered will be excluded prior to randomization.

Answer: D