Implementation of a restrictive blood transfusion protocol in a gynecologic oncology service

Abstract

Objectives: The purpose of this study was to evaluate the impact of a restrictive blood transfusion protocol in a postoperative gynecologic oncology population. The primary objective was the rate of blood transfusions after surgery before and after implementation of a restrictive transfusion protocol (from July 1 st 2011 to December 30 th 2016). Secondary outcomes were patient morbidity and included rates of surgical site infection, pneumonia, sepsis, unplanned intubation, prolonged ventilator use, renal insufficiency, acute renal failure, urinary tract infection, cerebral vascular accident, cardiac complications, venous thromboembolism, and death within 30 days of surgery, readmissions and length of stay. Methods: A restrictive blood transfusion protocol was implemented by the gynecologic oncology service at a National Comprehensive Cancer Network designated Comprehensive Cancer Centeron January 1 st , 2014. The restrictive protocol required that no patient receive a blood transfusion for hemoglobin greater than 7.0 g/dL (or hematocrit greater than 21.0%) and that all red blood cells were administered in one unit increments followed by re-evaluation of blood parameters. Exceptions to this protocol were postoperative symptomatic anemia, intraoperative or day of surgery transfusion, active bleeding, postoperative severe sepsis, postoperative active coronary ischemia, and postoperative transfusion after 1.5 liter or greater blood loss.Results: 1482 patients were identified for this study (755 in the pre-protocol group and 727 in the post-protocol group). Patients treated under the restrictive protocol had decreased rates of red blood cell transfusion (11.0% vs 5.9% p<0.001), superficial surgical site infection (7.7% vs 4.1% p=0.005), deep surgical site infection (2.3% vs 0.7% p=0.02), and median length of stay (3.0 days vs 2.0 days p<0.001). Conclusions: A restrictive blood transfusion protocol is associated with reductions in the ratesof blood transfusions and postoperative morbidity with a 46.8% reduction in superficial surgical site infection and a 69.6% decrease in deep surgical site infection in the gynecologic oncology patient population. Abstract Implementation of a restrictive blood transfusion protocol in a gynecologic oncology service.Citation: Mark J, Lynam S, Morrell K, et al. Implementation of a restrictive blood transfusion protocol in a gynecologic oncology service.. Gynecol Reproduct Endocrinol -UK. 2019;3(1):1-

Adverse postoperative outcomes associated with perioperative blood transfusion in gynecologic oncology surgery

“…The study also demonstrated that there was a cost savings of USD$161 112 over 1 year of the intervention without significantly affecting morbidity or mortality 27. Similarly, another institution reported a decrease in transfusion (11.0% to 5.9%, p<0.001), superficial surgical site infection (7.7% to 4.1%, p=0.005), deep surgical site infection (2.3% to 0.7%, p=0.02), and median length of stay (3.0 days to 2.0 days, p>0.001) after implementation of a restrictive transfusion protocol 28. There are also opportunities for improvement in evaluation and treatment of preoperative anemia in gynecologic oncology patients by applying the Using Blood Wisely benchmarks,15 preoperative optimization with intravenous iron,15 and intraoperative tranexamic acid,29 which could impact requirements for transfusion 30…”

A vértakarékos betegellátás bevezetésének szükségessége és lehetőségei, valamint a pandémia hatása a regionális vérellátás helyzetére

“…A megszorító elvek biztonságosan alkalmazhatónak bizonyultak a legtöbb sebészeti, belgyógyászati ágazatban, a szülészeti és az intenzív osztályos betegeknél is [20][21][22][23]. Az onkológiai betegek esetében a libe-rális elvek érvényesülése alacsonyabb mortalitással járt, így a restrikció erre a betegcsoportra nem vonatkozik [24], a nőgyógyászati onkológiai betegeknél viszont a restriktív értékek alkalmazásának előnyei fi gyelhetők meg [25]. A restrikciós ajánlás alkalmazása azonban kontraindikált hemodinamikai instabilitás és miokardiális iszkémia esetén, súlyos trombocitopeniában és krónikusan transzfúziót igénylő anémiában, valamint elegendő evidencia hiánya miatt akut koronária-szindrómában.…”