Donald J Lucas1, Aslam Ejaz2, Gaya Spolverato3, Yuhree Kim3, Faiz Gani3, Steven M Frank4, Timothy M Pawlik5. 1. Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA. 2. Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA. 3. Division of Surgical Oncology, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street Blalock 665, Baltimore, MD 21287, USA. 4. Department of Anesthesiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. 5. Division of Surgical Oncology, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street Blalock 665, Baltimore, MD 21287, USA. Electronic address: tpawlik1@jhmi.edu.
Abstract
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.
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.
Authors: Qinyu Chen; Fabio Bagante; Katiuscha Merath; Jay Idrees; Eliza W Beal; Jordan Cloyd; Mary Dillhoff; Carl Schmidt; Adrian Diaz; Susan White; Timothy M Pawlik Journal: World J Surg Date: 2018-09 Impact factor: 3.352