Gender disparities in red blood cell transfusion in elective surgery: a post hoc multicentre cohort study

Abstract

ObjectivesA post hoc gender comparison of transfusion-related modifiable risk factors among patients undergoing elective surgery.Settings23 Austrian centres randomly selected and stratified by region and level of care.ParticipantsWe consecutively enrolled in total 6530 patients (3465 women and 3065 men); 1491 underwent coronary artery bypass graft (CABG) surgery, 2570 primary unilateral total hip replacement (THR) and 2469 primary unilateral total knee replacement (TKR).Main outcome measuresPrimary outcome measures were the number of allogeneic and autologous red blood cell (RBC) units transfused (postoperative day 5 included) and differences in intraoperative and postoperative transfusion rate between men and women. Secondary outcomes included perioperative blood loss in transfused and non-transfused patients, volume of RBCs transfused, perioperative haemoglobin values and circulating red blood volume on postoperative day 5.ResultsIn all surgical groups, the transfusion rate was significantly higher in women than in men (CABG 81 vs 49%, THR 46 vs 24% and TKR 37 vs 23%). In transfused patients, the absolute blood loss was higher among men in all surgical categories while the relative blood loss was higher among women in the CABG group (52.8 vs 47.8%) but comparable in orthopaedic surgery. The relative RBC volume transfused was significantly higher among women in all categories (CABG 40.0 vs 22.3; TKR 25.2 vs 20.2; THR 26.4 vs 20.8%). On postoperative day 5, the relative haemoglobin values and the relative circulating RBC volume were higher in women in all surgical categories.ConclusionsThe higher transfusion rate and volume in women when compared with men in elective surgery can be explained by clinicians applying the same absolute transfusion thresholds irrespective of a patient's gender. This, together with the common use of a liberal transfusion strategy, leads to further overtransfusion in women.

Open versus robotic partial nephrectomy: Systematic review and meta‐analysis of contemporary studies

“…The superiority of RaPN was strengthened in female patients in meta‐regression analysis. Our finding supported that RaPN may reduce overtransfusion in women secondary to liberal transfusion strategy and nonsex specific transfusion threshold …”

Development of Multivariable Models to Predict and Benchmark Transfusion in Elective Surgery Supporting Patient Blood Management

“…In a recent publication we assumed that this is due to clinicians applying the same absolute transfusion thresholds irrespective of a patient's gender. This, together with the common use of a liberal transfusion strategy despite the recommendations in relevant guidelines, may lead to over-transfusion in women [21]. These findings will be applied to future predictive models in order to further optimize PBM in women.…”

Predictors of bleeding or anemia requiring transfusion in complex endovascular aortic repair and its impact on outcomes in health insurance claims

“…This sex difference is not completely new. In a large multicenter study enrolling 6530 patients with elective cardiac surgery, hip replacement surgery, and knee replacement surgery, Gombotz et al 23 found higher transfusion rates and volume in women compared with men. The authors concluded that clinicians tend to apply the same absolute transfusion thresholds for both sexes, leading to overtransfusion in female patients.…”