Dataset Information

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

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. 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.

SUBMITTER: Unal D

PROVIDER: S-EPMC7375885 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

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

Unal Dilek D Senayli Yesim Y Polat Reyhan R Spahn Donat R DR Toraman Fevzı F Alkis Neslıhan N Zekeriyya Alanoglu A Bahar Aydinli A Onat Bermede Ahmet BA Hulya Bilgin B Mehmet Buget B Nesil Coskunfirat C Asli Demir D Suna Goren G Meltem Guner Can GC Mukadder Orhan O Mert Senturk S Busra Tezcan T Ilksen Toprak Huseyin TH Cigdem Yildirim Guclu YG Suheyla Abitagaoglu A Yesim Abut A Arzu Akdaglı Ekici AE Esra Akdas Tekin AT Ali Akdogan A Mine Akin A Nukhet Akovali A Mustafa Aksoy Semsi AS Ergin Alaygut A Cavidan Arar Makbule AM Sule Arican A Gulbin Arici Ayse AA Emine Arik A Esma Arik A Mahmut Arslan A Necmiye Ay A Zuhal Aykac A Hilal Ayoglu A Cumhur Basaran B Volkan Baytas B Nurdan Bedirli B Azize Bestas B Zekiye Bigat B Ugur Bilgin Mehmet BM Faruk Boran Omer BO Sibel Buyukcoban B Sanem Cakar Turhan CT Meltem Cakmak C Baris Cankaya C Ayse Capar C Zubeyir Cebeci C Banu Cetinkaya Ethemoglu Filiz CEF Faruk Cicekci C Alkin Colak C Ziya Colak Yusuf CY Esra Dagli D Fisun Demir Hafize DH Abdurrahim Derbent D Ayca Dumanlı Ozcan DO Osman Ekinci E Gulay Erdogan Kayhan EK Engin Erturk E Ipek Erus E Tekeli Arzu Esen AE Mehmet Gamli G Basak Gulel G Gamze Gulgun G Emel Gunduz G Isin Gunes G Betul Guven Aytac GA Gulcin Hacibeyoglu H Nazan Has Selmi HS Ozgen Ilgaz Kocyigit IK Ayse Ilksen Egilmez IE Muzeyyen Iyigun I Inci Kara K Deniz Karakaya K Derya Karasu K Arzu Karaveli K Duygu Kavas Ayse KA Mensure Kaya K Suleyman Kaya K Zuleyha Kazak Bengisun KB Gulsen Keskin K Oya Kilci K Yeliz Kilic K Pakize Kirdemir K Zeynep Koc K Ceren Koksal K Betul Kozanhan K Semih Kucukguclu K Gamze Kucukosman K Ilke Kupeli K Aysun Kurtay K Omer Kurtipek K Ceyda Meco Basak MB Burak Nalbant N Dilek Okyay Rahsan OR Dilek Omur O Yavuz Orak O Elif Ounde O Esra Özayar Ö Menekse Ozcelik O Sabri Ozden Eyup OE Yetkin Ozer O Aysegul Ozgok O Ozgur Ozhan Mehmet OM Onur Ozlu O Ozlem Sagir S Arzu Saglik S Aslinur Sagun S Mehmet Sahap S Cihan Sahin S Yeliz Sahiner S Nevriye Salman S Ayten Saracoglu S Tolga Saracoglu Kemal SK Hilal Sarizeybek S Gokce Selcuk Sert SS Betul Sen S Ozlem Sen S Bengi Sener Elif SE Isil Sengul Fatma SF Emin Silay S Dilek Subası Ferhunde SF Ebru Tarikci Kilic TK Nilay Tas T Tuncel Tekgul Zeki TZ Sibel Tekgunduz T Gonul Tezcan Keles TK Hulya Topcu T Abdurrahman Tunay T Fatih Ugun U Canan Un U Petek Unal U Suheyla Unver U Gulcin Ural Sedef US Filiz Uzumcugil U Selcan Yerebakan Akesen YA Kadir Yesildal Y Mustafa Yildirim Y Aysun Yildiz Altun YA Munise Yildiz Y Hatice Yilmaz Erisen YE Hakan Yilmaz Y Mehmet Yilmaz Y Nureddin Yuzkat Y

Blood transfusion = Trasfusione del sangue 20200701 4

<h4>Background</h4>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).<h4>Materials and methods</h4>This was a multicentre, prospective, observational, cross-sectional study that included 61 centres. Clinical and transfusion data ...[more]

PMID: 32697928

Similar Datasets

Project description:BackgroundLittle is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards.ObjectiveTo observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome.DesignA multicentre observational study.SettingThe NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017.PatientsThe data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion.Main outcome measuresThe primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality.ResultsPeri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%.ConclusionsResults indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies.Trial registrationClinicalTrials.gov, identifier: NCT02350348.

Project description:BackgroundThe aim of this multicentre prospective observational study was to identify the incidence, patient characteristics, diagnostic pathway, management and outcome of acute mesenteric ischaemia (AMI).MethodsAll adult patients with clinical suspicion of AMI admitted or transferred to 32 participating hospitals from 06.06.2022 to 05.04.2023 were included. Participants who were subsequently shown not to have AMI or had localized intestinal gangrene due to strangulating bowel obstruction had only baseline and outcome data collected.ResultsAMI occurred in 0.038% of adult admissions in participating acute care hospitals worldwide. From a total of 705 included patients, 418 patients had confirmed AMI. In 69% AMI was the primary reason for admission, while in 31% AMI occurred after having been admitted with another diagnosis. Median time from onset of symptoms to hospital admission in patients admitted due to AMI was 24 h (interquartile range 9-48h) and time from admission to diagnosis was 6h (1-12 h). Occlusive arterial AMI was diagnosed in 231 (55.3%), venous in 73 (17.5%), non-occlusive (NOMI) in 55 (13.2%), other type in 11 (2.6%) and the subtype could not be classified in 48 (11.5%) patients. Surgery was the initial management in 242 (58%) patients, of which 59 (24.4%) underwent revascularization. Endovascular revascularization alone was carried out in 54 (13%), conservative treatment in 76 (18%) and palliative care in 46 (11%) patients. From patients with occlusive arterial AMI, revascularization was undertaken in 104 (45%), with 40 (38%) of them in one site admitting selected patients. Overall in-hospital and 90-day mortality of AMI was 49% and 53.3%, respectively, and among subtypes was lowest for venous AMI (13.7% and 16.4%) and highest for NOMI (72.7% and 74.5%). There was a high variability between participating sites for most variables studied.ConclusionsThe overall incidence of AMI and AMI subtypes varies worldwide, and case ascertainment is challenging. Pre-hospital delay in presentation was greater than delays after arriving at hospital. Surgery without revascularization was the most common management approach. Nearly half of the patients with AMI died during their index hospitalization. Together, these findings suggest a need for greater awareness of AMI, and better guidance in diagnosis and management.Trial registrationNCT05218863 (registered 19.01.2022).

Project description:Over 1.5 million major surgical procedures take place in the UK NHS each year and approximately 25% of patients develop at least one complication. The most widely used risk-adjustment model for postoperative morbidity in the UK is the physiological and operative severity score for the enumeration of mortality and morbidity. However, this model was derived more than 30 years ago and now overestimates the risk of morbidity. In addition, contemporary definitions of some model predictors are markedly different compared with when the tool was developed. A second model used in clinical practice is the American College of Surgeons National Surgical Quality Improvement Programme risk model; this provides a risk estimate for a range of postoperative complications. This model, widely used in North America, is not open source and therefore cannot be applied to patient populations in other settings. Data from a prospective multicentre clinical dataset of 118 NHS hospitals (the peri-operative quality improvement programme) were used to develop a bespoke risk-adjustment model for postoperative morbidity. Patients aged ≥ 18 years who underwent colorectal surgery were eligible for inclusion. Postoperative morbidity was defined using the postoperative morbidity survey at postoperative day 7. Thirty-one candidate variables were considered for inclusion in the model. Death or morbidity occurred by postoperative day 7 in 3098 out of 11,646 patients (26.6%). Twelve variables were incorporated into the final model, including (among others): Rockwood clinical frailty scale; body mass index; and index of multiple deprivation quintile. The C-statistic was 0.672 (95%CI 0.660-0.684), with a bootstrap optimism corrected C-statistic of 0.666 at internal validation. The model demonstrated good calibration across the range of morbidity estimates with a mean slope gradient of predicted risk of 0.959 (95%CI 0.894-1.024) with an index-corrected intercept of -0.038 (95%CI -0.112-0.036) at internal validation. Our model provides parsimonious case-mix adjustment to quantify risk of morbidity on postoperative day 7 for a UK population of patients undergoing major colorectal surgery. Despite the C-statistic of < 0.7, our model outperformed existing risk-models in widespread use. We therefore recommend application in case-mix adjustment, where incorporation into a continuous monitoring tool such as the variable life adjusted display or exponentially-weighted moving average-chart could support high-level monitoring and quality improvement of risk-adjusted outcome at the population level.

Dataset Information

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

Background

Materials and methods

Results

Conclusions

Publications

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

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets