Peri-operative blood transfusion in elective major surgery: incidence, indications and outcome – an observational multicentre study

Ünal D., Şenaylı Y., Polat R., Spahn D. R., Toraman F., Alkış N., ...More

TRANSFUSION MEDICINE, vol.18, no.4, pp.261-279, 2020 (SCI-Expanded)

  • Publication Type: Article / Article
  • Volume: 18 Issue: 4
  • Publication Date: 2020
  • Doi Number: 10.2450/2020.0011-20
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, CAB Abstracts, EMBASE, MEDLINE, Veterinary Science Database
  • Page Numbers: pp.261-279
  • Dokuz Eylül University Affiliated: Yes


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. Specific 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. Keywords: Blood components, patient blood management, peri-operative, transfusion