Red blood cell transfusion practices amongst Canadian anesthesiologists: a survey

To assess red blood cell transfusion practices among Canadian anesthesiologists.A survey depicting three realistic clinical scenarios of elective surgical procedures with different risks of bleeding was administered to all Canadian practicing members (n = 2,100) of the Canadian Anesthesiologists' Society. Respondents were requested to choose hemoglobin thresholds for which they would transfuse red blood cells under various conditions within each scenario.We obtained a response rate of 47% (719/1,512). Transfusion thresholds differed significantly between baseline scenarios. A threshold above 70 g x L(-1) was chosen by 48% of respondents in the general surgery scenario compared to 56% in the orthopedic surgery scenario and 79% in the vascular surgery scenario (P0.001). A history of coronary artery disease was associated with a transfusion thresholdor= 100 g x L(-1) in a significant proportion of respondents ranging from 20% in the orthopedic surgery scenario to 31% in the general surgery scenario and to 49% in the vascular surgery scenario (P0.001). Conversely, changing the patient's age from 60 to 20 yr resulted in the adoption of a transfusion thresholdor= 60 g x L(-1) by30% of respondents in two scenarios (P0.001). The year of respondent graduation was strongly associated with these findings.There was significant variation in transfusion practices among Canadian anesthesiologists. The type of surgical procedure, patient's age and a history of coronary artery disease influenced reported transfusion threshold. Practice variation in specific subgroups would support the need for further research to identify optimal transfusion thresholds.