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The second Austrian benchmark study for blood use in elective surgery: results and practice change
Hans Gombotz1, Peter H Rehak, Aryeh Shander
1Department of Anesthesiology and Intensive Care, General Hospital Linz, Linz, Austria.
Transfusion
|May 9, 2014
Summary
This study evaluated the impact of a prior benchmark on blood transfusions. While rates decreased for hip and knee replacements, they remained stable for bypass surgery, highlighting ongoing variability and the need for better anemia management.
Area of Science:
- Medicine
- Surgery
- Anesthesiology
Background:
- A previous benchmark study in Austria revealed high rates of blood transfusions, including non-indicated ones, in elective surgeries.
- This follow-up study was conducted five years later to assess the impact of the initial benchmark findings.
Purpose of the Study:
- To evaluate the effect of the first Austrian benchmark study on transfusion rates and practices.
- To identify current transfusion trends and variations across different surgical centers.
Main Methods:
- Data were collected from 3164 patients undergoing primary unilateral total hip replacement (THR), total knee replacement (TKR), or coronary artery bypass graft (CABG) surgery.
- Transfusion rates and red blood cell (RBC) loss were compared to the first benchmark study across 15 orthopedic and six cardiac centers.
Main Results:
- Transfusion rates decreased in THR (41% to 30%) and TKR (41% to 25%), but showed no change in CABG (57% vs. 55%).
- Over 80% of transfusions involved at least 2 units of RBCs, with significant intercenter variations in transfusion rates and RBC loss.
- Patients receiving transfusions had a threefold higher prevalence of anemia, yet preoperative anemia was largely untreated.
Conclusions:
- The second benchmark study indicates modest reductions in RBC transfusions and RBC loss, alongside persistent intercenter variability.
- Relative RBC volume loss, preoperative hemoglobin, and postoperative nadir hemoglobin were key predictors of transfusion.
- Inadequate treatment of preoperative anemia underscores the critical need for patient blood management strategies.
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