Transfusion rates vary significantly amongst Canadian medical centres

Hutton, Brian; Fergusson, Dean; Tinmouth, Alan; McIntyre, Lauralyn; Kmetic, Andrew; Hébert, Paul C.

doi:10.1007/bf03015766

Cited by 88 publications

(70 citation statements)

References 24 publications

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“…Despite evidence and clinical guidelines supporting restrictive strategies for blood transfusions, practices still vary significantly, [32][33][34][35] such that RBCT is still considered an overused treatment. 36,37 When such gaps between practice and guidelines exist, the most effective strategy to ensure successful changes requires practice-specific data on which to base tailored approaches to knowledge translation.…”

Section: Discussionmentioning

confidence: 99%

The impact of blood transfusion on perioperative outcomes following gastric cancer resection: an analysis of the American College of Surgeons National Surgical Quality Improvement Program database

et al. 2016

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Background: Red blood cell transfusions (RBCT) carry risk of transfusion-related immunodulation that may impact postoperative recovery. This study examined the association between perioperative RBCT and short-term postoperative outcomes following gastrectomy for gastric cancer. Methods:Using the American College of Surgeons National Surgical Quality Improvement Program database, we compared outcomes of patients (transfused v. nontransfused) undergoing elective gastrectomy for gastric cancer (2007)(2008)(2009)(2010)(2011)(2012). Outcomes were 30-day major morbidity, mortality and length of stay. The association between perioperative RBCT and outcomes was estimated using modified Poisson, logistic, or negative binomial regression. Results:Of the 3243 patients in the entire cohort, we included 2884 patients with nonmissing data, of whom 535 (18.6%) received RBCT. Overall 30-day major morbidity and mortality were 20% and 3.5%, respectively. After adjustment for baseline and clinical characteristics, RBCT was independently associated with increased 30-day mortality (relative risk [RR] 3.1, 95% confidence interval [CI] 1.9-5.0), major morbidity (RR 1.4, 95% CI 1.2-1.8), length of stay (RR 1.2, 95% CI 1.1-1.2), infections (RR 1.4, 95% CI 1.1-1.6), cardiac complications (RR 1.8, 95% CI 1.0-3.2) and respiratory failure (RR 2.3, 95% CI 1.6-3.3). Conclusion:Red blood cell transfusions are associated with worse postoperative short-term outcomes in patients with gastric cancer. Blood management strategies are needed to reduce the use of RBCT after gastrectomy for gastric cancer.Contexte : Les transfusion de globules rouges (TGR) entrainent une immunosuppression qui peut entraver la récupération post-opératoire. Cette étude évalue l'association entre les TGR péri-opératoires et l'issue post-opératoire après gastrectomie pour cancer gastrique (CG). Conclusion :Les TGR sont associées à une détérioration de l'issue post-opératoire après gastrectomie pour CG, dont la morbidité majeure, la mortalité, et la durée d'hospitalisation. Des stratégies multidisciplinaires de gestion du risque transfusionnel sont nécessaires afin de limiter l'utilisation des TGRs après gastrectomie pour CG.

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Section: Discussionmentioning

confidence: 99%

The impact of blood transfusion on perioperative outcomes following gastric cancer resection: an analysis of the American College of Surgeons National Surgical Quality Improvement Program database

et al. 2016

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“…According to a Canadian retrospective study on more than 11,800 patients undergoing cardiac surgeries, the mean hemoglobin concentration for blood transfusion was 72.5 ± 10.7 g/l. 3 The transfusion trigger among the included trials, however, ranged from 70 to 100 g/l of hemoglobin concentration. This concentration can exaggerate the beneficial findings of the studies in terms of the incidence or the amount of blood transfusion.…”

Section: Discussionmentioning

confidence: 99%

“…Hence, in most centres, a median of 2 to 3 units of red blood cells (RBCs) per patient is required. 3 Patients undergoing cardiac surgery are vulnerable to the consequences of blood loss which can lead to increased mortality, morbidity, and poor quality of life. 4 Issues such as the cost of blood, limited availability, and the potentially harmful effects of transfusion necessitate developing more effective methods to minimize surgical blood loss.…”

Section: Introductionmentioning

confidence: 99%

Topical application of antifibrinolytic drugs for on-pump cardiac surgery: a systematic review and meta-analysis

Abrishami

Chung

Wong

2009

Can J Anesth/J Can Anesth

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Purpose This systematic review aimed to evaluate the efficacy and safety of topical application of antifibrinolytic drugs to reduce postoperative bleeding and transfusion requirements in patients undergoing on-pump cardiac surgery. Methods We searched The Cochrane Library, MED-LINE, EMBASE and SCI-EXPANDED for all randomized controlled trials on the topic. Trial inclusion, quality assessment, and data extraction were performed independently by two authors. Standard meta-analytic techniques were applied. Results Eight trials (n = 622 patients) met our inclusion criteria. The medication/placebo was applied into the pericardial cavity and/or mediastinum at the end of cardiac surgery. Seven trials compared antifibrinolytic agents (aprotinin or tranexamic acid) versus placebo. They showed that, on average, topical use of antifibrinolytic agents reduced the amount of 24-h postoperative chest tube (blood) loss by 220 ml (95% confidence interval: -318 to -126, P \ 0.00001, I 2 = 93%) and resulted in a saving of 1 unit of allogeneic red blood cells per patient (95% confidence interval: -1.54 to -0.53, P \ 0.0001, I 2 = 55%). The incidence of blood transfusion was not significantly changed following topical application of the medications. One study comparing topical versus intravenous administration of aprotinin found comparable results between the two methods of administration for the abovementioned outcomes. No adverse effects were reported following topical use of the medications. Conclusion This review suggests that topical application of antifibrinolytics can reduce postoperative bleeding and transfusion requirements in patients undergoing on-pump cardiac surgery. These promising findings need to be confirmed by more trials with large sample size using patient-related outcomes and more assessments regarding the systemic absorption of the medications. RésuméObjectif Le but de cette e´tude me´thodique e´tait d'e´valuer l'efficacite´et l'innocuite´de l'application topique d'agents anti-fibrinolytiques afin de re´duire les saignements et les besoins transfusionnels postope´ratoires chez les patients subissant une chirurgie cardiaque avec circulation extracorporelle. Méthode Nous avons fouille´les bases de donne´es suivantes afin d'extraire toutes les e´tudes randomise´es contrôle´es traitant de cette question : The Cochrane Library, MEDLINE, EMBASE et SCI-EXPANDED. L'inclusion des e´tudes, l'e´valuation de la qualite´et l'extraction des donne´es ont e´te´re´alise´es de façon inde´-pendante par deux auteurs. Des techniques de me´ta-analyse standard ont e´te´utilise´es. Résultats Huit e´tudes (n = 622 patients) ont satisfait aǹ os crite`res d'inclusion. Le me´dicament/placebo a e´teá pplique´dans la cavite´pe´ricardique et/ou dans le me´dia-stin a`la fin de la chirurgie cardiaque. Sept e´tudes ont compare´des agents anti-fibrinolytiques (aprotinine ou acide tranexamique) a`un placebo. Ces e´tudes ont montre´que, en moyenne, l'application topique d'agents

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“…Despite randomized controlled trials and associated clinical practice guidelines supporting restrictive transfusion strategies in critical care and surgical settings, transfusion practices vary significantly (7,(17)(18)(19)(20)(21)(22)(23). As many as one out of two RBCT administered in hepatobiliary surgery is considered unnecessary according to those guidelines (7,18,40).…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, transfusion practices vary significantly in both overall rates of RBCT use and triggers for RBCT administration (7,17). A number of medical societies have endorsed the use of restrictive transfusion strategies, based on evidence from randomized controlled trials (18)(19)(20)(21)(22)(23).…”

Section: Introductionmentioning

confidence: 99%

The impact of perioperative blood transfusions on short-term outcomes following hepatectomy

Hallet¹,

Mahar²,

Nathens³

et al. 2018

Hepatobiliary Surg. Nutr.

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Background: Bleeding and need for red blood cell transfusions (RBCT) remain a significant concern with hepatectomy. RBCT carry risk of transfusion-related immunomodulation that may impact post-operative recovery. This study soughs to assess the association between RBCT and post-hepatectomy morbidity. Two exposure groups were created based on RBCT. Primary outcomes were 30-day major morbidity and mortality. Secondary outcomes included 30-day system-specific morbidity and length of stay (LOS). Relative risks (RR) with 95% confidence interval (95% CI) were computed using regression analyses. Sensitivity analyses were conducted to understand how missing data might have impacted the results.Results: A total of 12,180 patients were identified. Of those, 11,712 met inclusion criteria, 2,951 (25.2%) of whom received RBCT. Major morbidity occurred in 14.9% of patients and was strongly associated with RBCT (25.3% vs. 11.3%; P<0.001). Transfused patients had higher rates of 30-day mortality (5.6% vs. 1.0%; P<0.0001). After adjustment for baseline and clinical characteristics, RBCT was independently associated with increased major morbidity (RR 1.80; 95% CI: 1.61-1.99), mortality (RR 3.62; 95% CI: 2.68-4.89), and 1.29 times greater LOS (RR 1.29; 95% CI: 1.25-1.32). Results were robust to a number of sensitivity analyses for missing data.Conclusions: Perioperative RBCT for hepatectomy was independently associated with worse shortterm outcomes and prolonged LOS. These findings further the rationale to focus on minimizing RBCT for hepatectomy, when they can be avoided.

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Transfusion rates vary significantly amongst Canadian medical centres

Cited by 88 publications

References 24 publications

The impact of blood transfusion on perioperative outcomes following gastric cancer resection: an analysis of the American College of Surgeons National Surgical Quality Improvement Program database

The impact of blood transfusion on perioperative outcomes following gastric cancer resection: an analysis of the American College of Surgeons National Surgical Quality Improvement Program database

Topical application of antifibrinolytic drugs for on-pump cardiac surgery: a systematic review and meta-analysis

The impact of perioperative blood transfusions on short-term outcomes following hepatectomy

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