Assessment of intraoperative blood transfusion practice during elective non-cardiac surgery in an Indian tertiary care hospital.

BACKGROUND: We assessed appropriate intraoperative use of whole blood during elective surgery.
METHODS: This prospective observational audit by a team of anaesthetists over 3 months in a multi-speciality tertiary care teaching hospital used strict preset criteria to evaluate the use of blood transfusion during elective surgery by anaesthetists. The criteria used to evaluate the rate of appropriate transfusion were haemoglobin less than 8 g x dl(-1), haemoglobin less than 10 g x dl(-1) in patients with medical co-morbidities and blood loss greater than 20% of blood volume when more than 1000 ml.
RESULTS: The overall rate of appropriate use of blood was 40.7%; it was inappropriate in 19.2% of cases (haemoglobin >11 g x dl(-1)). The primary trigger was low haemoglobin (measured intraoperatively or derived from blood loss). Patients in whom haemoglobin was measured intraoperatively had a significantly higher appropriate use of blood (P<0.05). There was a reduction in blood use over the 3-month audit period (P<0.05).
CONCLUSIONS: Current intraoperative blood use is sub-optimal. Intraoperative haemoglobin estimation is an effective and simple measurement to improve appropriate use of blood. The indication for transfusion should be recorded in the case notes.