The ongoing variability in blood transfusion practices in cardiac surgery

Area of Science:

• Cardiology
• Transfusion Medicine
• Healthcare Management

Background:

• Blood utilization in surgery has faced scrutiny for 20 years.
• Comparative studies on international perioperative transfusion practices are scarce.
• International standards for transfusion practices remain unclear.

Purpose of the Study:

• To compare perioperative blood component transfusion in cardiac surgery across multiple international centers.
• To identify variations in transfusion practices globally.

Main Methods:

• Prospective investigation of transfusion practices in 70 centers across 16 countries.
• Evaluation of 5065 cardiac surgery patients from the EPI II Study.
• Daily assessment of red blood cell (RBC), fresh-frozen plasma (FFP), and platelet (PLT) utilization pre-, intra-, and post-operatively.

Main Results:

• Significant variation in intraoperative and postoperative transfusion rates for RBCs, FFP, and PLTs among countries.
• Wide discrepancies in transfusion frequencies observed both between countries and between institutions within countries.
• RBC transfusion rates varied from 9-100% intraoperatively and 25-87% postoperatively.

Conclusions:

• Marked variability in transfusion practices suggests differences in perioperative care and potential inappropriate use.
• International standardization of perioperative practices and transfusion regimens is essential.
• Need for consistent global guidelines in cardiac surgery transfusion.