Implementation of a restrictive blood transfusion protocol in a gynecologic oncology service
Jaron Mark1, Sarah Lynam1, Kayla Morrell2
1Department of Gynecologic Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA.
Insights
Implementing a restrictive blood transfusion protocol in gynecologic oncology patients significantly reduced red blood cell transfusions and surgical site infections. This approach also led to a shorter hospital stay, improving patient outcomes post-surgery.
Area of Science:
- Oncology
- Hematology
- Surgical Outcomes
Background:
- Postoperative anemia is common in gynecologic oncology patients.
- Blood transfusions carry inherent risks and costs.
- Optimizing transfusion strategies is crucial for patient recovery and safety.
Purpose of the Study:
- To evaluate the impact of a restrictive blood transfusion protocol.
- To assess changes in transfusion rates and postoperative morbidity.
- To analyze outcomes in gynecologic oncology patients before and after protocol implementation.
Main Methods:
- A restrictive blood transfusion protocol was implemented in January 2014.
- Transfusions were restricted to hemoglobin <7.0 g/dL or hematocrit <21.0% in one-unit increments.
- Patient data were collected from July 2011 to December 2016, comparing pre- and post-protocol periods.
Main Results:
- A total of 1482 patients were analyzed (755 pre-protocol, 727 post-protocol).
- Restrictive protocol patients showed decreased red blood cell transfusion rates (11.0% vs 5.9%, p<0.001).
- Significant reductions were observed in superficial (7.7% vs 4.1%, p=0.005) and deep surgical site infections (2.3% vs 0.7%, p=0.02), and length of stay (3.0 vs 2.0 days, p<0.001).
Conclusions:
- A restrictive blood transfusion protocol effectively reduces transfusion rates in gynecologic oncology patients.
- This protocol is associated with decreased postoperative morbidity, including surgical site infections.
- The findings support the adoption of restrictive transfusion strategies to improve outcomes in this patient population.
Objectives:
The purpose of this study was to evaluate the impact of a restrictive blood transfusion protocol in a postoperative gynecologic oncology population. The primary objective was the rate of blood transfusions after surgery before and after implementation of a restrictive transfusion protocol (from July 1st 2011 to December 30th 2016). Secondary outcomes were patient morbidity and included rates of surgical site infection, pneumonia, sepsis, unplanned intubation, prolonged ventilator use, renal insufficiency, acute renal failure, urinary tract infection, cerebral vascular accident, cardiac complications, venous thromboembolism, and death within 30 days of surgery, readmissions and length of stay.
Methods:
A restrictive blood transfusion protocol was implemented by the gynecologic oncology service at a National Comprehensive Cancer Network designated Comprehensive Cancer Center on January 1st, 2014. The restrictive protocol required that no patient receive a blood transfusion for hemoglobin greater than 7.0 g/dL (or hematocrit greater than 21.0%) and that all red blood cells were administered in one unit increments followed by re-evaluation of blood parameters. Exceptions to this protocol were postoperative symptomatic anemia, intraoperative or day of surgery transfusion, active bleeding, postoperative severe sepsis, postoperative active coronary ischemia, and postoperative transfusion after 1.5 liter or greater blood loss.
Results:
1482 patients were identified for this study (755 in the pre-protocol group and 727 in the post-protocol group). Patients treated under the restrictive protocol had decreased rates of red blood cell transfusion (11.0% vs 5.9% p<0.001), superficial surgical site infection (7.7% vs 4.1% p=0.005), deep surgical site infection (2.3% vs 0.7% p=0.02), and median length of stay (3.0 days vs 2.0 days p<0.001).
Conclusions:
A restrictive blood transfusion protocol is associated with reductions in the rates of blood transfusions and postoperative morbidity with a 46.8% reduction in superficial surgical site infection and a 69.6% decrease in deep surgical site infection in the gynecologic oncology patient population.
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