TY - JOUR
T1 - Packed red blood cell transfusion after surgery
T2 - are we “overtranfusing” our patients?
AU - Lucas, Donald J.
AU - Ejaz, Aslam
AU - Spolverato, Gaya
AU - Kim, Yuhree
AU - Gani, Faiz
AU - Frank, Steven M.
AU - Pawlik, Timothy M.
N1 - Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2016/7/1
Y1 - 2016/7/1
N2 - 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.
AB - 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.
KW - Outcomes
KW - Overtransfusion
KW - Target
KW - Transfusion
KW - Trigger
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U2 - 10.1016/j.amjsurg.2015.12.020
DO - 10.1016/j.amjsurg.2015.12.020
M3 - Article
C2 - 27036620
AN - SCOPUS:84962081636
SN - 0002-9610
VL - 212
SP - 1
EP - 9
JO - American journal of surgery
JF - American journal of surgery
IS - 1
ER -