Peri-operative blood transfusion in elective major surgery: incidence, indications and outcome – an observational multicentre study

Background - Patients’ demographic and epidemiological characteristics,local variations in clinicians’ knowledge and experience and types of surgerycan influence peri-operative transfusion practices. Sharing data on transfusionpractices and recipients may improve patients’ care and implementation ofPatient Blood Management (PBM).Materials and methods - This was a multicentre, prospective, observational,cross-sectional study that included 61 centres. Clinical and transfusion dataof patients undergoing major elective surgery were collected; transfusionpredictors and patients’ outcomes were analysed.Results - Of 6,121 patients, 1,579 (25.8%) received a peri-operative transfusion.A total of 5,812 blood components were transfused: red blood cells (RBC),fresh-frozen plasma and platelets in 1,425 (23.3%), 762 (12.4%) and 88(1.4%) cases, respectively). Pre-operative anaemia was identified in 2,019(33%) patients. Half of the RBC units were used by patients in the age group45-69 years. Specific procedures with the highest RBC use were coronaryartery bypass grafting (16.9% of all units) and hip arthroplasty (14.9%).Low haemoglobin concentration was the most common indication forintra-operative RBC transfusion (57%) and plasma and platelet transfusionswere mostly initiated for acute bleeding (61.3% and 61.1%, respectively).The RBC transfusion rate in study centres varied from 2% to 72%. RBCtransfusion was inappropriate in 99% (n=150/151) of pre-operative, 23%(n=211/926) of intra-operative and 43% (n=308/716) of post-operative RBCtransfusion episodes. Pre-operative haemoglobin, increased blood loss, opensurgery and duration of surgery were the main independent predictors ofintra-operative RBC transfusion. Low pre-operative haemoglobinconcentration was independently associated with post-operative pulmonarycomplications.Conclusions - These findings identified areas for improvement inperi-operative transfusion practice and PBM implementation in Turkey.Keywords: Blood components, patient blood management, peri-operative, transfusion