Intraoperative Red Blood Cell Transfusion Decision-making

Baker, Laura; Park, Lily; Gilbert, Richard; Ahn, Hilalion; Martel, Andre B.; Lenet, Tori; Davis, Alexandra; McIsaac, Daniel I.; Tinmouth, Alan; Fergusson, Dean; Martel, Guillaume

doi:10.1097/sla.0000000000004710

Cited by 36 publications

(29 citation statements)

References 73 publications

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“…Patient blood management (PBM) has been introduced in the last decade to reduce the use of blood products and improve tolerance to anemia [10][11][12][13][14]. Most data regarding the relationship between the implementation of PBM and the reduction in the consumption of blood products come from North America [14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Implementation of a patient blood management in an Italian City Hospital: is it effective in reducing the use of red blood cells?

et al. 2022

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To evaluate the effect of patient blood management (PBM) since its introduction, we analyzed the need for transfusion and the outcomes in patients undergoing abdominal surgery for different types of tumor pre- and post-PBM. Patients undergoing elective gastric, liver, pancreatic, and colorectal surgery between 2017 and 2020 were included. The implementation of the PBM program was completed on May 1, 2018. The patients were grouped as follows: those who underwent surgery before the implementation of the program (pre-PBM) versus after the implementation (post-PBM). A total of 1302 patients were included in the analysis (445 pre-PBM vs. 857 post-PBM). The number of transfused patients per year decreased significantly after the introduction of PBM. A strong tendency for a decreased incidence of transfusion was evident in gastric and pancreatic surgery and a similar decrease was statistically significant in liver surgery. With regard to gastric surgery, a single-unit transfusion scheme was used more frequently in the post-PBM group (7.7% vs. 55% after PBM; p = 0.049); this was similar in liver surgery (17.6% vs. 58.3% after PBM; p = 0.04). Within the subgroup of patients undergoing liver surgery, a significant reduction in the use of blood transfusion (20.5% vs. 6.7%; p = 0.002) and a decrease in the Hb trigger for transfusion (8.5, 8.2–9.5 vs. 8.2, 7.7–8.4 g/dl; p = 0.039) was reported after the PBM introduction. After the implementation of a PBM protocol, a significant reduction in the number of patients receiving blood transfusion was demonstrated, with a strong tendency to minimize the use of blood products for most types of oncologic surgery.

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Section: Introductionmentioning

confidence: 99%

Implementation of a patient blood management in an Italian City Hospital: is it effective in reducing the use of red blood cells?

et al. 2022

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“… 23 Second, hemodynamic variations in surgical patients are not necessarily reflective of anemia from surgical bleeding, and may result from other factors such as pharmacologic anesthetic agents, patient positioning, mechanical ventilation, neuraxial analgesia, surgical manipulation, and abdominal insufflation. 24 , 25 A comprehensive synthesis of randomized trials comparing intraoperative transfusion strategies does not exist, and is thus timely and necessary.…”

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confidence: 99%

A Systematic Review and Meta-analysis of Randomized Controlled Trials Comparing Intraoperative Red Blood Cell Transfusion Strategies

et al. 2021

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Objective: The objective of this work was to carry out a meta-analysis of RCTs comparing intraoperative RBC transfusion strategies to determine their impact on postoperative morbidity, mortality, and blood product use. Summary of Background Data: RBC transfusions are common in surgery and associated with widespread variability despite adjustment for casemix. Evidence-based recommendations guiding RBC transfusion in the operative setting are limited. Methods: The search strategy was adapted from a previous Cochrane Review. Electronic databases were searched from January 2016 to February 2021. Included studies from the previous Cochrane Review were considered for eligibility from before 2016. RCTs comparing intraoperative transfusion strategies were considered for inclusion. Co-primary outcomes were 30-day mortality and morbidity. Secondary outcomes included intraoperative and perioperative RBC transfusion. Meta-analysis was carried out using random-effects models. Results: Fourteen trials (8641 patients) were included. One cardiac surgery trial accounted for 56% of patients. There was no difference in 30-day mortality [relative risk (RR) 0.96, 95% confidence interval (CI) 0.71–1.29] and pooled postoperative morbidity among the studied outcomes when comparing restrictive and liberal protocols. Two trials reported worse composite outcomes with restrictive triggers. Intraoperative (RR 0.53, 95% CI 0.43–0.64) and perioperative (RR 0.70, 95% CI 0.62–0.79) blood transfusions were significantly lower in the restrictive group compared to the liberal group. Conclusions: Intraoperative restrictive transfusion strategies decreased perioperative transfusions without added postoperative morbidity and mortality in 12/14 trials. Two trials reported worse outcomes. Given trial design and generalizability limitations, uncertainty remains regarding the safety of broad application of restrictive transfusion triggers in the operating room. Trials specifically designed to address intraoperative transfusions are urgently needed.

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“…However, the fundamental purpose of medical treatment is not to treat “laboratory values,” but to improve patients’ conditions to achieve a better outcome ( 41 ). The indication of allogeneic blood transfusion should take into account the patient’s underlying disease ( 42 ), laboratory test results, benefits and risks, and whether bleeding is present or absent ( 43 – 45 ). Patient blood management (PBM) has encouraged physicians to treat anemia, optimize hemostasis, minimize blood loss, promote toleration of anemia, and restrict transfusion where appropriate in order to improve patient prognosis ( 15 , 43 , 46 – 49 ).…”

Section: Discussionmentioning

confidence: 99%

Anemia tolerance versus blood transfusion on long-term outcomes after colorectal cancer surgery: A retrospective propensity-score-matched analysis

Weng

Guo

et al. 2022

Front. Oncol.

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BackgroundPerioperative anemia and transfusion are intertwined with each other, and both have adverse impacts on the survival of colorectal cancer (CRC) patients. But the treatment of anemia still relies on transfusion in several countries, which leads us to question the effects of anemia tolerance and transfusion on the long-term outcomes of CRC patients. We investigated the combined effect of preoperative anemia and postoperative anemia and of preoperative anemia and blood transfusion, which imposes a greater risk to survival, to compare the effects of anemia tolerance and transfusion on overall survival (OS) and disease-free survival (DFS) in patients undergoing CRC surgery.MethodsA retrospective propensity-score-matched analysis included patients with CRC undergoing elective surgery between January 1, 2008, and December 31, 2014. After propensity-score matching, Kaplan–Meier survival analysis and univariable and multivariable Cox proportional hazards models were used to study the prognostic factors for survivals. In univariate and multivariate Cox regression analysis, two novel models were built.ResultsOf the 8,121 patients with CRC, 1,975 (24.3%) and 6,146 (75.7%) patients presented with and without preoperative anemia, respectively. After matching, 1,690 patients remained in each group. In the preoperative anemia and postoperative anemia model, preoperative anemia and postoperative anemia was independent risk factor for OS (HR, 1.202; 95% CI, 1.043–1.385; P=0.011) and DFS (HR, 1.210; 95% CI, 1.050–1.395; P=0.008). In the preoperative anemia and transfusion model, preoperative anemia and transfused was the most dangerous independent prognostic factor for OS (HR, 1.791; 95% CI, 1.339–2.397; P<0.001) and DFS (HR, 1.857; 95% CI, 1.389–2.483; P<0.001). In patients with preoperative anemia, the OS and DFS of patients with transfusion were worse than those of patients without transfusion (P=0.026 in OS; P=0.037 in DFS).ConclusionsPreoperative anemia and blood transfusion imposed a greater risk to OS and DFS in patients undergoing CRC surgery, indicating that the harm associated with blood transfusion was greater than that associated with postoperative anemia. These findings should encourage clinicians to be vigilant for the timely prevention and treatment of anemia, by appropriately promoting toleration of anemia and restricting the use of blood transfusion in patients with CRC.

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Intraoperative Red Blood Cell Transfusion Decision-making

Abstract: Supplemental Digital Content is available in the text

Cited by 36 publications

References 73 publications

Implementation of a patient blood management in an Italian City Hospital: is it effective in reducing the use of red blood cells?

Implementation of a patient blood management in an Italian City Hospital: is it effective in reducing the use of red blood cells?

A Systematic Review and Meta-analysis of Randomized Controlled Trials Comparing Intraoperative Red Blood Cell Transfusion Strategies

Anemia tolerance versus blood transfusion on long-term outcomes after colorectal cancer surgery: A retrospective propensity-score-matched analysis

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