Safety and Effectiveness of Reduced Red Blood Cells Consumption in Spine Surgery under the Guidance of West China Perioperative Transfusion Score (WCPTS): A Prospective, Randomized, Controlled Trial

Abstract

Background: Transfusion trigger and target for surgical patients with hemoglobin (Hb) level between 7-10 per deciliter is not available worldwide, and the decision of whether red blood cells (RBCs) should be administered in these patients is made according to the experience of clinicians without evidences. Based on the physiology of the balance between oxygen supply and consumption, we suggested West China Perioperative Transfusion Score (WCPTS) to be safely applied to the patients undergoing spine surgery with effective reduction of RBCs transfusion. Methods: We enrolled patients who were aged 15 to 70 years undergoing elective spine surgery with the expected blood loss more than 800 ml or 20% of the patient's whole blood volume. We randomly assigned patients to the WCPTS group (transfusion threshold under guidance of WCPTS) or the liberal-strategy group (transfusion threshold of 10 per deciliter). The primary outcomes were the proportion of patients who received RBCs transfusion and the units of transfused RBCs. Results: The proportion of patients who received RBCs transfusion in the WCPTS group was significantly lower than that in the liberal-strategy group at all observed time periods (intraoperative: 24.0% vs. 88.2% , P<0.001; postoperative: 18.8% vs. 44.7% , P<0.001; perioperative: 36.5% vs. 89.4% , P<0.001). A median of zero units of RBCs were transfused in the WCPTS group and 3.5 units in the liberal-strategy group during perioperative period (P<0.001). The frequencies of in-hospital complication did not differ significantly between the two groups (P>0.05), and there were no significant between-group differences in length of stay in hospital, length of stay after operation, stitches removal time, time to normal life, and time to work in the two groups (P>0.05). Conclusions: An objective evaluation of the status of oxygen supply and consumption could be achieved by application of WCPTS for patients with Hb level between 7-10 g/dl, and RBCs transfusion trigger and target could be determined on the basis of the evaluation, thus requirement of RBCs transfusion could be reduced by more than 70% under the guidance of WCPTS safely and effectively.

A physiology‐based trigger score to guide perioperative transfusion of allogeneic red blood cells: A multicentre randomised controlled trial

“…In a previous trial in patients undergoing elective spine surgery with expected blood loss more than 800 ml or exceeding 20% total blood volume, 6,45 In contrast to reduced transfusion volume with POTTS in a previous trial by Zhu et al, 46 transfusion volume did not differ between the two groups in the current study. Such a discrepancy may be attributed to several reasons, including higher percentage of transfusion due to higher percentage of patients with cancer in the previous trial, and the use of intraoperative blood salvage in the current study.…”

“…In a previous trial in patients undergoing elective spine surgery with expected blood loss more than 800 ml or exceeding 20% total blood volume, 6,45 the rate of RBCs transfusion was 36.5% in the POTTS group versus 89.4% in the control group with liberal transfusion strategy. The current study compared POTTS versus restrictive blood transfusion, a strategy recommended by major guidelines and widely used in clinical practice.…”

West China Liu's Score for Individualized Red Cells Transfusion Strategy in Non-Cardiac Surgery: Study Protocol for a Multicenter, Randomized, Controlled Trial

“…We also set the power to be 90% for each outcome. In our pilot study comparing transfusion guided by individualized and liberal transfusion strategy, we found that among 191 of patients, 36.5% in the individualized group and 89.4% in the liberal group (P<0.001) received red cells transfusion in perioperative period, and a median of zero units of red cells were transfused in the individualized group and 3.5 units in the liberal group (P<0.001) (8). Besides, we sampled 400 records of blood transfusion in spine surgeries with blood loss more than 800 ml from 2006 to 2009 in West China Hospital, Sichuan University, and found that 76.7% patients received red cells transfusion and the number of transfused Red cells units was 2.7 U on average.…”

An Individualized Red Blood Cell Transfusion Strategy Using Pediatric Perioperative-Transfusion-Trigger Score Reduced Perioperative Blood Exposure for Children: A Randomized Controlled Clinical Trial

“…[14] This semi-quantitative score could be applied by any physician without complex measurements. [10,15] Above all, the pediatric individual transfusion strategy was designed in order to reduce perioperative blood exposure in children. The reason why this strategy was able to reduce the amount of RBC transfusion may be multifactorial.…”

“…We conducted a clinical trial of adult patients with spinal surgery and the results suggested this individualized strategy was safe and costeffective. [10] Based on this score, taking account of children's age and developmental stage, we designed a Pediatric Perioperative-Transfusion-Trigger Score (Pediatric-POTTS) (Table 1) to guide transfusion in children. We designed this trial to test the hypothesis that transfusion guided by the individualized strategy could decrease exposure to blood, without increasing perioperative complications in children.…”