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Perioperative Transfusion Trigger Score Versus Restrictive Transfusion in Older Non-Cardiac Surgery Patients: A

Shucong Liang1,2, Lijuan Bai1,2, Guizhen Yang1,2

  • 1Department of Anesthesiology, The Third Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.

Journal of the American Geriatrics Society
|June 30, 2026
PubMed
Summary

The Perioperative Transfusion Trigger Score (POTTS) safely reduced red blood cell transfusions in older adults undergoing non-cardiac surgery. This score-guided approach decreased transfusion rates without increasing patient complications.

Keywords:
blood transfusionolder patientsperioperative transfusion trigger scorerestrictive transfusion strategy

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Area of Science:

  • Anesthesiology
  • Hematology
  • Geriatric Medicine

Background:

  • Restrictive transfusion thresholds (Hb < 7 g/dL) are standard, but optimal triggers for patients with cardiovascular disease or Hb 7-10 g/dL remain unclear.
  • The Perioperative Transfusion Trigger Score (POTTS) integrates physiological parameters to guide transfusion decisions.
  • POTTS may standardize transfusion practices and reduce unnecessary transfusions in older surgical patients.

Purpose of the Study:

  • To evaluate the efficacy and safety of the POTTS-guided transfusion strategy compared to the standard guideline in older patients undergoing non-cardiac surgery.
  • To determine if POTTS can reduce the rate of allogeneic red blood cell transfusion.

Main Methods:

  • A multicenter randomized controlled trial (RCT) involving patients aged 60 years and above undergoing non-cardiac surgery.
  • Patients were randomized 1:1 to either the POTTS strategy or a control group following the 2012 AABB guideline.
  • The POTTS strategy involved transfusing patients when Hb < POTTS score, calculated based on adrenaline, FiO2, temperature, and angina history.

Main Results:

  • A total of 253 patients were randomized. The POTTS group showed a significantly lower transfusion rate (24.00%) compared to the control group (35.94%, p=0.038).
  • There were no significant differences in transfusion volume or overall complication rates between the two groups.
  • One death occurred in the control group, with no significant differences in specific complications observed.

Conclusions:

  • The POTTS-guided transfusion strategy significantly reduced the proportion of patients receiving red blood cell transfusions.
  • This approach was effective in older patients undergoing non-cardiac surgery without an increase in complications.
  • POTTS offers a standardized method for perioperative transfusion management in this patient population.