High inappropriate red blood cell transfusion rate despite low overall use: a real-world multicenter study in 43...

Since their implementation in Spain, adherence of hospitals to Patient Blood Management (PBM) programs has been variable, potentially influencing transfusion practices. This study aimed to evaluate, in a real-world surgical setting, the frequency and appropriateness of red blood cell (RBC) transfusion.

A prospective multicenter study in 43 Spanish hospitals including surgical patients. Transfusion appropriateness was evaluated using evidence-based criteria based on hemoglobin thresholds and clinical conditions such as cardiovascular disease, acute hemorrhage, or high comorbidity burden. Statistical analyses identified factors associated with transfusion practices.

The overall perioperative RBC transfusion rate was 9.7%, with the highest rates in cardiac (52.9%), vascular (17.9%), and orthopedic (12.3%) surgeries. RBC transfusion was associated with older patients with comorbidities, lower preoperative hemoglobin, higher ASA score and worse surgical meters and postoperative outcomes. Transfused patients showed significantly lower 60-day survival. Critically, 43% of transfusions were inappropriate, while transfusion omission (1.9%) may represent a clinical concern that warrants further investigation. Inappropriate transfusion was more frequent in older comorbidity patients according to Charlson Comorbidity Index in urgent surgery. In multivariable analysis, age was a factor associated with inappropriate transfusion, by cons, surgical blood loss was the main protective factor against inappropriate transfusion.

As far as we know, this is the first Spanish multicenter study evaluating transfusion appropriateness in surgical scenario. Despite a lower overall transfusion rate than international figures, nearly half of transfusions were inappropriate and transfusion omission, also represents a real clinical concern. Implementation of decision-support tools and strengthened PBM protocols are needed to address factors associated with inappropriate transfusion, such as age, and to optimize patient safety and resource use.