Peri-operative blood transfusion in elective major surgery: incidence, indications and outcome - an observational multicentre study.
Dilek Ünal, Yeşim Şenaylı, Reyhan Polat, Donat R. Spahn, Fevzı Toraman, Neslihan Alkış, Alanoglu Zekeriyya, Aydinli Bahar, Alanoglu Zekeriyya, Aydinli Bahar, Bermede Ahmet Onat, Bilgin Hulya, Buget Mehmet, Coskunfirat Nesil, Demir Asli, Goren Suna, Guner Can Meltem, Orhan Mukadder, Senturk Mert, Tezcan Busra, Toprak Huseyin Ilksen, Yildirim Guclu Cigdem, Abitagaoglu Suheyla, Abut Fatma Yeşim, Akdaglı Ekici Arzu, Akdaş Tekin Esra, A. Akdoğan, Akin Mine, Akovali Nukhet, Mustafa Aksoy, A. Ergin, Arar Makbule Cavidan, Arican Sule, Arici Ayse Gulbin, Arik Emine, Arik Esma, Arslan Mahmut, Ay Necmiye, Aykac Zuhal, Ayoglu Hilal, Basaran Cumhur, Baytas Volkan, Bedirli Nurdan, Bestas Azize, Zekiye Bıgat, Buyukcoban Sibel, Cakar Turhan Sanem, Buyukcoban Sibel, Cakar Turhan Sanem, Cakmak Meltem, Barış Çankaya, Capar Ayse, Zübeyir Cebeci, Cetinkaya Ethemoglu Filiz Banu, Cicekci Faruk, Alkın Çolak, Colak Yusuf Ziya, Dagli Esra, Demir Hafize Fisun, Derbent Abdurrahim, Dumanlı Ozcan Ayca, Osman Ekinci, Erus Ipek, Erturk Engin, Erus Ipek, Arzu Esen Tekeli, Mehmet Gamlı, Gulel Basak, Gulgun Gamze, Gunduz Emel, Gunes Isin, Guven Aytac Betul, Hacibeyoglu Gulcin, Has Selmi Nazan, Ilgaz Kocyigit Ozgen, Ilksen Egilmez Ayse, Iyigun Muzeyyen, Kara Inci, Deni̇z Karakaya, Derya Karasu, Karaveli Arzu, Kavas Ayse Duygu, Kaya Mensure, Kaya Suleyman, Kazak Bengisun Zuleyha, Keskin Gulsen, Kilci Oya, Kilic Yeliz, Kirdemir Pakize, Koc Zeynep, Koksal Ceren, Kozanhan Betul, Kucukguclu Semih, Gamze Küçükosman, Kupeli Ilke, Kurtay Aysun, Kurtipek Omer, Okyay Rahsan Dilek, Nalbant Burak, Okyay Rahsan Dilek
Abstract
BACKGROUND: Patients' demographic and epidemiological characteristics, local variations in clinicians' knowledge and experience and types of surgery can influence peri-operative transfusion practices. Sharing data on transfusion practices and recipients may improve patients' care and implementation of Patient Blood Management (PBM). MATERIALS AND METHODS: This was a multicentre, prospective, observational, cross-sectional study that included 61 centres. Clinical and transfusion data of patients undergoing major elective surgery were collected; transfusion predictors and patients' outcomes were analysed. RESULTS: Of 6,121 patients, 1,579 (25.8%) received a peri-operative transfusion. A total of 5,812 blood components were transfused: red blood cells (RBC), fresh-frozen plasma and platelets in 1,425 (23.3%), 762 (12.4%) and 88 (1.4%) cases, respectively). Pre-operative anaemia was identified in 2,019 (33%) patients. Half of the RBC units were used by patients in the age group 45-69 years. Specific procedures with the highest RBC use were coronary artery bypass grafting (16.9% of all units) and hip arthroplasty (14.9%). Low haemoglobin concentration was the most common indication for intra-operative RBC transfusion (57%) and plasma and platelet transfusions were mostly initiated for acute bleeding (61.3% and 61.1%, respectively). The RBC transfusion rate in study centres varied from 2% to 72%. RBC transfusion was inappropriate in 99% (n=150/151) of pre-operative, 23% (n=211/926) of intra-operative and 43% (n=308/716) of post-operative RBC transfusion episodes. Pre-operative haemoglobin, increased blood loss, open surgery and duration of surgery were the main independent predictors of intra-operative RBC transfusion. Low pre-operative haemoglobin concentration was independently associated with post-operative pulmonary complications. CONCLUSIONS: These findings identified areas for improvement in peri-operative transfusion practice and PBM implementation in Turkey.