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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

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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

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Project description:Background:Pulmonary segmentectomies are generally classified into simple (tri-segmentectomy or lingulectomy as well as apical or basilar segmentectomy) and complex (individual or bi-segmentectomy of the upper, middle and lower lobes). Complex segmentectomies are technically feasible by video-assisted thoracic surgery (VATS) but remain challenging, and reports on post-operative outcomes are scarce. This study analyzes the differences between simple and complex VATS segmentectomy in terms of peri- and post-operative outcomes. Methods:We retrospectively reviewed records of all patients who underwent anatomical pulmonary segmentectomy by VATS from 2014 to 2018 in two university hospitals. Results:A total of 232 patients (114 men; median age 67 years; range, 29-87 years) underwent VATS segmentectomy for primary lung cancer (n=177), metastases (n=26) and benign lesions (n=29). The overall 30-day mortality and morbidity rates were 0.8% and 29.7%, respectively. The re-operation rate was 4.7%. Complex segmentectomy was realized in 111 patients including 86 (77.5%) upper lobe segmentectomies and 44 (39.6%) bi-segmentectomies. There was no statistical difference between complex and simple segmentectomy in terms of operative time (145 vs. 143 min, respectively; P=0.79) and chest tube duration [median: 1 (range, 0-33) vs. 2 (range, 1-19) days, respectively; P=0.95]. Post-operative overall complication rates were similar for both groups (30% vs. 30%, respectively; P=0.99) and were not correlated with the type of segmentectomy. However, complex segmentectomy patients had a shorter length of hospitalization compared to simple segmentectomy patients [median: 5 (range, 1-36) vs. 7 (range, 2-31) days; P=0.026]. Interestingly, complex segmentectomies were realized most frequently 2 years after implementation of VATS segmentectomy (23% vs. 77%; P=0.01). Conclusions:In comparison with simple segmentectomy, complex segmentectomy by VATS seems to present similar post-operative complication rates. Learning curve and progressive increase in acceptance by surgeons seem to be key elements for successful implementation of complex segmentectomies and could explain the shorter length of stay we observed.

Dataset Information

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

Publications

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

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