CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Editor: Deborah Sesok-Pizzini, MD, MBA, professor, Department of Clinical Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and chief, Division of Transfusion Medicine, Children’s Hospital of Philadelphia.
Trends in perioperative RBC transfusion from index cases in five surgical specialties
July 2018—In recent years, greater attention has been given to patient blood management. While contemporary national guidelines recommend restrictive red blood cell transfusion, it is not known whether such transfusions have decreased in surgical patients. Approximately 11 million RBC transfusions are performed annually, and two-thirds of those are for patients in the perioperative period.
The authors conducted a study to analyze whether RBC transfusions are decreasing in surgical patients. They performed a retrospective review of the National Surgical Quality Improvement Program database from 2011 through 2015 and studied five surgical specialties: neurosurgery, thoracic surgery, gynecologic surgery, orthopedic surgery, and vascular surgery. The study compared patient characteristics, preoperative laboratory values, and surgery details. The primary outcome was perioperative RBC transfusion, which was compared over the five-year period. The results showed that RBC transfusion decreased in all surgical specialties except thoracic and gynecologic surgery. The most significant decrease occurred in orthopedic patients, falling from 22.4 percent in 2011 to 6.3 percent in 2015 (P≤.0001). Of interest, high-risk patients had a greater reduction in the number of transfusions compared with low-risk patients, and there were no increases in myocardial infarction or renal failure in any specialty after surgery. The authors concluded that their study shows that RBC transfusions are decreasing among multiple surgical specialties, with no apparent increase in the adverse events of renal failure or myocardial infarction. Due to the infectious and noninfectious complications of blood transfusions, restricting RBC transfusions is important. This study suggests that an upswing in patient blood-management programs and increasing provider awareness are helping to reduce unnecessary transfusions.
Mazzeffi MA, See JM, Williams B, et al. Five-year trends in perioperative red blood cell transfusion from index cases in five surgical specialties: 2011 to 2015. Transfusion. 2018;58:1271–1278.