Validation of a New Method to Automatically Select Cases With Intraoperative Red Blood Cell Transfusion for Audit

Area of Science:

• Transfusion Medicine
• Healthcare Quality Improvement
• Surgical Outcomes

Background:

• Hospitals routinely audit allogeneic red blood cell (RBC) transfusions for appropriateness.
• Published audit criteria exist for five common procedures.
• This study expands audit criteria to all surgical procedures involving at least one RBC unit.

Purpose of the Study:

• To study the management decision for selecting transfusion cases for audit.
• To develop criteria for auditing RBC transfusions across all surgical procedures.

Main Methods:

• Retrospective observational study of 400,000 cases across 1891 procedures over 11 years.
• Analyzed 12,616 cases with RBC transfusion.
• Evaluated audit criteria based on nadir hemoglobin (Hb) and estimated blood loss (EBL), particularly for procedures with median EBL <500 mL.

Main Results:

• Over 50% of audited cases and transfused cases occurred in procedures with median EBL <500 mL.
• Cases with transfusion and nadir Hb >9 g/dL were 3.0 times more frequent in procedures with median EBL <500 mL.
• Missing Hb or EBL data led to more audit recommendations than exceeding Hb thresholds in procedures with median EBL ≥500 mL.

Conclusions:

• Automated audit processes for RBC transfusions should incorporate median EBL, nadir Hb thresholds, and the presence of Hb/EBL data.
• These considerations are crucial for optimizing the audit of intraoperative RBC transfusions in all surgical settings.