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Multicenter Study
. 2016 Dec 13;6(12):e012210.
doi: 10.1136/bmjopen-2016-012210.

Gender disparities in red blood cell transfusion in elective surgery: a post hoc multicentre cohort study

Hans Gombotz  1   2 , Günter Schreier  2 , Sandra Neubauer  2 , Peter Kastner  2 , Axel Hofmann  3   4   5
Affiliations
Multicenter Study

Gender disparities in red blood cell transfusion in elective surgery: a post hoc multicentre cohort study

Hans Gombotz et al. BMJ Open. .

Abstract

Objectives: A post hoc gender comparison of transfusion-related modifiable risk factors among patients undergoing elective surgery.

Settings: 23 Austrian centres randomly selected and stratified by region and level of care.

Participants: We consecutively enrolled in total 6530 patients (3465 women and 3065 men); 1491 underwent coronary artery bypass graft (CABG) surgery, 2570 primary unilateral total hip replacement (THR) and 2469 primary unilateral total knee replacement (TKR).

Main outcome measures: Primary outcome measures were the number of allogeneic and autologous red blood cell (RBC) units transfused (postoperative day 5 included) and differences in intraoperative and postoperative transfusion rate between men and women. Secondary outcomes included perioperative blood loss in transfused and non-transfused patients, volume of RBCs transfused, perioperative haemoglobin values and circulating red blood volume on postoperative day 5.

Results: In all surgical groups, the transfusion rate was significantly higher in women than in men (CABG 81 vs 49%, THR 46 vs 24% and TKR 37 vs 23%). In transfused patients, the absolute blood loss was higher among men in all surgical categories while the relative blood loss was higher among women in the CABG group (52.8 vs 47.8%) but comparable in orthopaedic surgery. The relative RBC volume transfused was significantly higher among women in all categories (CABG 40.0 vs 22.3; TKR 25.2 vs 20.2; THR 26.4 vs 20.8%). On postoperative day 5, the relative haemoglobin values and the relative circulating RBC volume were higher in women in all surgical categories.

Conclusions: The higher transfusion rate and volume in women when compared with men in elective surgery can be explained by clinicians applying the same absolute transfusion thresholds irrespective of a patient's gender. This, together with the common use of a liberal transfusion strategy, leads to further overtransfusion in women.

Keywords: Patient blood management; gender; overuse; transfusion.

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Conflict of interest statement

AH lectures for Vifor Pharma and TEM international.

Figures

Figure 1
Figure 1
Boxplots for absolute versus relative haemoglobin values. The significant gender difference in haemoglobin values (left) disappears by using relative values according the WHO guidelines (right). Hb, haemoglobin.
Figure 2
Figure 2
Type of surgery and percentage of patients transfused. CABG, coronary artery bypass graft; THR, total hip replacement; TKR, total knee replacement.
Figure 3
Figure 3
Percentage of patients receiving a given number of RBC units (indicating that women received one or two RBC units more often as men do, mostly at the expense of the percentage of patients who did not receive any transfusion. RBC, red blood cell.
Figure 4
Figure 4
(A and B) Transfusion rate in patients with anaemia (top) and non-anaemia (bottom). CABG, coronary artery bypass graft; THR, total hip replacement; TKR, total knee replacement.
Figure 5
Figure 5
(A–C) Boxplots for absolute and relative RBC volumes: lost (left) and transfused (right) for CABG (top), THR (middle), TKR (bottom)—women versus men for transfused patients only. CABG, coronary artery bypass graft; RBC, red blood cell; THR, total hip replacement; TKR, total knee replacement.
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