Abstract

Background - Patients’ demographic and epidemiological characteristics, local variations in clinicians’ knowledge and experience and types of surgery can influence peri-operative transfusion practices. Sharing data on transfusion practices and recipients may improve patients’ care and implementation of patient blood management (PBM).
Materials and methods - This was a multicentre, prospective, observational, cross-sectional study that included 61 centres. Clinical and transfusion data of patients undergoing major elective surgery were collected; transfusion predictors and patients’ outcomes were analysed.
Results - Of 6,121 patients, 1,579 (25.8%) received a peri-operative transfusion. A total of 5,812 blood components were transfused: red blood cells (RBC),fresh-frozen plasma and platelets in 1,425 (23.3%), 762 (12.4%) and 88 (1.4%) cases, respectively). Pre-operative anaemia was identified in 2,019 (33%) patients. Half of the RBC units were used by patients in the age group 45-69 years. Speci?c procedures with the highest RBC use were coronary artery bypass grafting (16.9% of all units) and hip arthroplasty (14.9%). Low haemoglobin concentration was the most common indication for intra-operative RBC transfusion (57%) and plasma and platelet transfusions were mostly initiated for acute bleeding (61.3% and 61.1%, respectively). The RBC transfusion rate in study centres varied from 2% to 72%. RBC transfusion was inappropriate in 99% (n=150/151) of pre-operative, 23% (n=211/926) of intra-operative and 43% (n=308/716) of post-operative RBC transfusion episodes. Pre-operative haemoglobin, increased blood loss, open surgery and duration of surgery were the main independent predictors of intra-operative RBC transfusion. Low pre-operative haemoglobin concentration was independently associated with post-operative pulmonary complications.
Conclusions - These findings identified areas for improvement in peri-operative transfusion practice and PBM implementation in Turkey.

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Authors

Dilek Unal - Department of Anaesthesiology and Reanimation, University of Health Sciences Diskapi Yildirim Beyazit Teaching Hospital, Ankara, Turkey

Yesim Senayli - Department of Anaesthesiology and Reanimation, “Ankara Gulhane” Teaching Hospital, Ankara, Turkey

Reyhan Polat - Department of Anaesthesiology and Reanimation, University of Health Sciences Diskapi Yildirim Beyazit Teaching Hospital, Ankara, Turkey

Donat R. Spahn - Institute of Anaesthesiology, University of Zurich and University Hospital Zurich, Zurich, Switzerland

Fevzı Toraman - Department of Anaesthesiology, “Acibadem Mehmet Ali Aydınlar” University School of Medicine, Istanbul, Turkey

Neslıhan Alkis - for the Turkish Society of Anaesthesiology and Reanimation Patient Blood Management Group and the Turkish National Perioperative Transfusion Study Investigators (the collaborators are listed in the Appendix 1); Department of Anaesthesiology and Reanimation, Ankara University Medical Faculty, Ankara, Turkey

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