Transfusion rates in emergency general surgery: high but modifiable

Area of Science:

• Surgical Outcomes
• Patient Safety
• Transfusion Medicine

Background:

• Red blood cell (RBC) transfusions are associated with increased morbidity and mortality.
• Emergency general surgery (EGS) patients face higher risks due to case complexity and acuity.
• Transfusion reduction strategies and blood conservation technologies aim to minimize RBC use.

Purpose of the Study:

• To investigate the trend of RBC transfusion rates in EGS.
• To determine if implemented transfusion reduction strategies have impacted EGS transfusion rates.

Main Methods:

• Retrospective review of the American College of Surgeons' National Surgical Quality Improvement Program (ACS NSQIP) data.
• Analysis of adult general surgery cases from three academic medical centers across two periods: 2011-2013 and 2014-2016.
• Transfusion defined as RBC transfusion during or within 72 hours post-operation; morbidity defined as any NSQIP complication within 30 days.

Main Results:

• Overall EGS transfusion rates decreased from 6.4% to 4.8% (p<0.001).
• Transfusion rates declined in both emergent (16.6% to 11.5%) and non-emergent (4.9% to 3.7%) cases.
• Composite morbidity decreased overall (13.8% to 12.3%, p=0.001) and in emergent cases (26.3% to 20.6%, p<0.001); mortality remained unchanged.

Conclusions:

• RBC transfusion rates have successfully decreased in both emergent and non-emergent EGS.
• Transfusion reduction efforts appear effective in the EGS population.
• Improvements in patient morbidity were observed, while mortality rates did not change significantly.