Fan 2014.

Study characteristics
Methods	Design: RCT Date of study: October 2011 to May 2013 Power calculation: no Inclusion criteria: patients older than 65 years undergoing elective unilateral total hip replacement surgery with spinal anaesthetic Exclusion criteria: ASA physical status 3 IV; preoperative delirium; unwilling to comply with the procedures; inability to understand the language (Mandarin Chinese); hearing loss, or a failure in spinal anaesthesia
Participants	Sample size:192 Country: China Setting: hospital inpatient – elective orthopaedics Age: mean age 73 (+/‐ 7) in the intervention group, 75 (+/‐ 6) in the control group Sex: male, 30, (31.9%) in the Intervention group, male, 32, (35.9%) in the control group Co‐morbidity: no baseline between‐group differences in CVD, IHD, CHF, hypertension, pulmonary disease, renal insufficiency, PVD, diabetes mellitus, liver disease. Dementia: not mentioned explicitly but cognitive assessment undertaken using MMSE Frailty: not reported
Interventions	Intervention: patients older than 65 years undergoing elective unilateral total hip replacement surgery with spinal anaesthetic. Control: ASA physical status 3 IV; preoperative delirium; unwilling to comply with the procedures; inability to understand the language (Mandarin Chinese); hearing loss, or a failure in spinal anaesthesia
Outcomes	Outcomes reported ‐ Incident delirium using the Confusion Assessment Method for the intensive care unit (CAM‐ICU) ‐ Length of stay ‐ Withdrawal Outcomes from study not reported: none Frequency of outcomes assessment: Delirium was assessed by the same attending anaesthesiologist between 8 a.m. and 9 a.m. preoperatively, and 1, 2, 3 days after surgery.
Notes	Funding source: this work was supported by the grants from the National Natural Science Foundation of China (No. 81300946) and the Natural Science Foundation of Jiangsu Province (BK2012778). Declarations of interest: no conflict of interest stated by authors Delirium excluded at enrolment using the (CAM‐ ICU) criteria (Chinese version) Imbalance between groups om other substances transfused – restrictive group received more Ringer’s lactate and hydroxyethyl starch
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Randomly assigned to restrictive or liberal group using a random number table
Allocation concealment (selection bias)	Unclear risk	The method used to was sealed envelope technique, however, there is insufficient detail as to whether these were opaque.
Blinding of participants and personnel (performance bias) All outcomes	High risk	No blinding of participants or personnel described
Blinding of outcome assessment (detection bias) All outcomes	High risk	No blinding of outcome assessments described
Incomplete outcome data (attrition bias) All outcomes	Low risk	Clear accounting for all participants at follow‐up. Loss of 2 from restrictive and 4 from liberal transfusion groups at follow‐up due to declined consent for transfusion.
Selective reporting (reporting bias)	Unclear risk	Insufficient information to assess as no published protocol
Other bias	Low risk	No evidence of other bias