Five‐year trends in perioperative red blood cell transfusion from index cases in five surgical specialties: 2011 to 2015

Mazzeffi, Michael; See, John M.; Williams, Brittney; Richards, Justin E.; Zimmerman, Darin; Galvagno, Samuel M.; Fontaine, Magali J.; Tanaka, Kenichi A.

doi:10.1111/trf.14559

Cited by 14 publications

(8 citation statements)

References 32 publications

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“…First, routine transfusion patterns revealed the idea of restrictive transfusion has already been embraced in clinical practice even 2‐3 years before publication of the new standard, with a much higher uptake compared with liberal practice. This is in line with foreign reports and can reinforce our confidence towards the roles played by the growth of transfusions evidence and guidelines. Second, however, one‐fifth of RBCs were still transfused at Hb ≥10 g/dl after our previous investigation in 2006–2009 .…”

Section: Discussionsupporting

confidence: 88%

Cost‐effectiveness comparison of routine transfusion with restrictive and liberal transfusion strategies for surgical patients in China

Wang

et al. 2019

Vox Sanguinis

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Background and Objectives A health industry standard recommending restrictive transfusion is to be in effect in China in April 2019. We aim to explore its potential economic and clinical impacts among surgical patients. Materials and Methods A decision tree model was applied to compare cost‐effectiveness of current routine transfusion in China, a restrictive (transfusion at Hb < 8 g/dl or ischaemic symptoms) and a liberal (transfusion at Hb < 10 g/dl) strategy. Parameters were estimated from empirical data of 25 227 surgical inpatients aged ≥30 years in a multicenter study and supplemented by meta‐analysis when necessary. Results are shown for cardio‐cerebral‐vascular (CCV) surgery and non‐CCV (orthopaedics, general, thoracic) surgery separately. Results Per 10 000 patients in routine, restrictive, liberal transfusion scenarios, total spending (transfusion and length of stay related) was 7·67, 7·58 and 9·39 million CNY (1 CNY × 0.157 = 1 US dollar) for CCV surgery and 6·35, 6·70 and 8·09 million CNY for non‐CCV surgery; infectious and severe complications numbered 354, 290, and 290 (CCV) and 315, 286, and 330 (non‐CCV), respectively. Acceptability curves showed high probabilities for restrictive strategy to be cost‐effective across a wide range of willingness‐to‐pay values. Such findings were mostly consistent in sensitivity and subgroup analyses except for patients with cardiac problems. Conclusion We showed strong rationale, succeeding previous findings only in cardiac or joint procedures, to comply with the new standard as restrictive transfusion has high potential to save blood, secure safety, and is cost‐effective for a wide spectrum of surgical patients. Experiences should be further summarized to pave the way towards individualized transfusion.

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Section: Discussionsupporting

confidence: 88%

Cost‐effectiveness comparison of routine transfusion with restrictive and liberal transfusion strategies for surgical patients in China

Wang

et al. 2019

Vox Sanguinis

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“…The transfusion rate for those undergoing cardiac surgery is likely to be increased or stationary, whereas it is decreased in orthopedic, neurogeneral, and gynecologic surgeries. 10,11 The association between RBC transfusion and adverse clinical outcomes in patients undergoing cardiac surgery has been well studied in retrospective analyses. 4,7,[12][13][14][15] However, there is a lack of evidence regarding the risk of RBC transfusion during heart valve surgery.…”

Section: Anesthesia and Analgesiamentioning

confidence: 99%

“…The transfusion rate for those undergoing cardiac surgery is likely to be increased or stationary, whereas it is decreased in orthopedic, neurogeneral, and gynecologic surgeries. 10,11…”

mentioning

confidence: 99%

Perioperative Red Blood Cell Transfusion Is Associated With Adverse Cardiovascular Outcomes in Heart Valve Surgery

Kim

Lee

et al. 2022

Anesthesia &Amp; Analgesia

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BACKGROUND: We examined the relationship between blood transfusion and long-term adverse events to evaluate the clinical impact of red blood cell (RBC) transfusion on patients undergoing cardiac valve surgery. METHODS: From the National Health Insurance Service database, individuals undergoing heart valve surgery were verified, including aortic valve (AV), mitral valve (MV), tricuspid valve (TV), and complex valves (more than 2 valve surgeries). The interested outcomes were incidence of death, ischemic stroke, hemorrhagic stroke, and admission for myocardial infarction during follow-up. Associations between perioperative RBC transfusion and long-term cardiovascular events were analyzed with Cox-proportional hazard model. RESULTS: Perioperative RBC transfusion (±2 days from the day of surgery) was categorized into 0, 1, 2, and >3 units based on the number of packs transfused. From 2003 to 2019, the data of 58,299 individuals were retrieved (51.6% were male and 58% were aged above 60 years). The median follow-up duration was 5.53 years. Of the total cohort, 86.5% received at least 1 transfusion. In multivariable analysis, adverse cardiovascular event risk proportionally increased with transfusion in a dose-dependent manner. The adjusted hazard ratios and 95% confidence intervals of outcomes after the transfusion of 1, 2, and ≥3 units compared to those with no transfusion were as follows: death, 1.53 (1.41–1.66), 1.97 (1.81–2.14), and 3.03 (2.79–3.29); ischemic stroke, 1.27 (1.16–1.39), 1.31 (1.19–1.44), and 1.51 (1.38–1.66); hemorrhagic stroke, 1.38 (1.16–1.66), 1.71 (1.43–2.05), and 2.31 (1.94–2.76); and myocardial infarction 1.35 (1.13–1.62), 1.60 (1.33–1.91), and 1.99 (1.66–2.38), respectively (all P < .01). CONCLUSIONS: In the analysis of the national cohort, perioperative RBC transfusion during heart valve surgery was associated with adverse cardiovascular outcomes correlated with the volume of RBC transfusion.

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“…111 PBM strategies have led to a substantial decline in blood transfusion in many developed countries over the past 5 years. [112][113][114][115][116][117][118][119][120] In parallel with reduction in blood transfusion, recent active surveillance studies of TACO and TRALI found lower incidence rates of transfusion-related adverse events. 5,9 Future directions…”

Section: Mitigationmentioning

confidence: 99%

TACO and TRALI: biology, risk factors, and prevention strategies

Roubinian

2018

Hematology

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Transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) are the leading causes of transfusion-related morbidity and mortality. These adverse events are characterized by acute pulmonary edema within 6 hours of a blood transfusion and have historically been difficult to study due to underrecognition and nonspecific diagnostic criteria. However, in the past decade, in vivo models and clinical studies utilizing active surveillance have advanced our understanding of their epidemiology and pathogenesis. With the adoption of mitigation strategies and patient blood management, the incidence of TRALI and TACO has decreased. Continued research to prevent and treat these severe cardiopulmonary events is focused on both the blood component and the transfusion recipient.

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Five‐year trends in perioperative red blood cell transfusion from index cases in five surgical specialties: 2011 to 2015

Cited by 14 publications

References 32 publications

Cost‐effectiveness comparison of routine transfusion with restrictive and liberal transfusion strategies for surgical patients in China

Cost‐effectiveness comparison of routine transfusion with restrictive and liberal transfusion strategies for surgical patients in China

Perioperative Red Blood Cell Transfusion Is Associated With Adverse Cardiovascular Outcomes in Heart Valve Surgery

TACO and TRALI: biology, risk factors, and prevention strategies

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