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Review
. 2021 Nov;61(11):3119-3128.
doi: 10.1111/trf.16677. Epub 2021 Oct 1.

Demonstration of a U.S. nationwide reduction in transfusion in general surgery and a review of published transfusion reduction methodologies

Courtney M Hamilton  1 , Daniel L Davenport  2 , Andrew C Bernard  2
Affiliations
Review

Demonstration of a U.S. nationwide reduction in transfusion in general surgery and a review of published transfusion reduction methodologies

Courtney M Hamilton et al. Transfusion. 2021 Nov.

Abstract

Background: Red blood cell transfusions in surgical procedures can be lifesaving. However, recent studies show transfusions are associated with a dose-dependent increase in postoperative morbidity and mortality; hospitals and physicians have attempted to reduce them. We sought to determine the success of these efforts and review and summarize published reduction methods employed.

Study design/methods: An analysis of transfusion data from ACS-NSQIP public use files of general surgical procedures for 2012 and 2018; a retrospective review of the literature surrounding general surgical transfusion reduction from 2008 to 2018.

Results: The rate of general surgical transfusion in the NSQIP dataset decreased from 5.5% in 2012 to 4.0% in 2018, a 27% relative reduction in transfusion. After extensive multivariable adjustment for patient risk and operative complexity, this effect remained (Odds ratio 0.65, 95% CI 0.63-0.67, p < .001). Furthermore, there was a positive correlation between specific procedure decreases in transfusion and decreases in 30-day morbidity (rho =0.41, p = .003) and mortality (rho = 0.37, p = .007). There were 866 published studies matching our search term "red blood cell transfusion reduction." Forty-four were relevant to general surgery. Seven dominant strategies for transfusion reduction by descending frequency of report included restrictive transfusion thresholds, management of preoperative anemia, perioperative interventions, educational programs, electronic clinical decision support, waste reduction, and audits of transfusion practices.

Conclusion: Our study demonstrates a 27% decrease in general surgery transfusion between 2012 and 2018 with associated reductions in morbidity and mortality, suggesting published employed strategies have been successful and safely implemented.

Keywords: NSQIP; red blood cells; retrospective; transfusion; transfusion reduction.

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References

REFERENCES

    1. Bernard AC, Davenport DL, Chang PK, Vaughan TB, Zwischenberger JB. Intraoperative transfusion of 1-2 units of packed red blood cells is associated with increased 30-day mortality, surgical site infection, pneumonia, and sepsis in general surgery patients. J Am Coll Surg. 2009;208(5):931-7. discussion 938-9.
    1. Murphy MF, Goodnough LT. The scientific basis for patient blood management. Transfus Clin Biol. 2015;22(3):90-6.
    1. White MJ, Hazard SW, Frank SM, Boyd JS, Wick EC, Ness PM, et al. The evolution of perioperative transfusion testing and blood ordering. Anesth Analg. 2015;120(6):1196-203.
    1. Goodnough LT, Levy JH, Murphy MF. Concepts of blood transfusion in adults. Lancet. 2013;381(9880):1845-54.
    1. Hébert PC, Schweitzer J, Calder L, et al. Review of the clinical practice literature on allogeneic red blood cell transfusion. Can Med Assoc J. 1997;156(11):S9-S26.

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