Packed red blood cell transfusion after surgery: are we “overtranfusing” our patients? - 20/06/16
Abstract |
Background |
Data on the hemoglobin (Hb) after transfusion, or the “target,” which reflects the “dose” of blood given are not well studied. We sought to examine the incidence and causes of “over transfusion” of red blood cells after surgery.
Methods |
Data on blood utilization including Hb triggers and targets were obtained for patients undergoing colorectal, pancreas, or liver surgery between 2010 and 2013.
Results |
A total of 2,905 patients were identified, of which 895 (31%) were transfused (median age 64, interquartile range: 53 to 72; 51% men; median American Society of Anesthesiologists class 3, interquartile range: 3–3; 51% pancreatic, 14% hepatobiliary, 21% colorectal, and 14% other). Among these, 512 (57%) were overtransfused (final Hb target after transfusion ≥9.0 g/dL). Among patients who were overtransfused, 171 (33%) were transfused at too high an initial trigger (>8.0 g/dL), whereas 304 (59%) had an appropriate trigger but received ≥2 packed red blood cell (PRBC) units, suggesting an opportunity to have transfused fewer units. There was significant variation in overtransfusion among surgeons (range 0% to 80%, P = .003).
Conclusions |
Excess use of blood transfusion is common and was due to PRBC utilization for too high a transfusion trigger, as well as too many units transfused.
Le texte complet de cet article est disponible en PDF.Highlights |
• | The current study examined the incidence of “over transfusion” after surgery. |
• | A hemoglobin level ≥9.0 g/dL after red cell transfusion was defined as an “overtransfusion.” |
• | Among transfused patients 57% were overtransfused. |
• | Risk factors for overtransfusion included a trigger ≥8.0 g/dL and transfusion of multiple units. |
Keywords : Transfusion, Trigger, Target, Outcomes, Overtransfusion
Plan
| The views expressed in this article are those of the authors and do not represent the official policy of the US Navy, Department of Defense, or US Government (DJL). |
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| There were no relevant financial relationships or any sources of support in the form of grants, equipment, or drugs. |
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| The authors declare no conflicts of interest. |
Vol 212 - N° 1
P. 1-9 - juillet 2016 Retour au numéro
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- Benchmarking hospital outcomes for improvement of care in Medicare elective colon surgery
- Donald E. Fry, Michael Pine, Susan M. Nedza, David G. Locke, Agnes M. Reband, Gregory Pine
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