Intraoperative Blood Transfusion Rate and Mortality
Intraoperative Blood Transfusion Rate and Mortality
Wu WC, Trivedi A, Friedmann PD, et al
Ann Surg. 2012;255:708-714
Is there variation in transfusion rates for patients with significant blood loss? If so, are transfusion rates related to overall mortality? The authors examined transfusion practices in 46,608 patients who were at least 65 years of age and hospitalized in Veterans Affairs hospitals. Estimated blood loss was > 500 mL in all patients. The authors found significant variation in transfusion rates, which ranged from 10%-92%. There was a negative correlation between transfusion rates and 30-day hospital mortality: increasing the transfusion rate by 10% lowered the mortality rate by about 0.7% (95% confidence interval, 0.3%-1.1%).
This large study found a surprising variation in institutional response to blood loss. Regression analysis suggested a moderately strong negative correlation between transfusion rate and mortality (r = -.31, P = <.01). This was not a randomized trial; therefore, other possible confounding factors may explain the results. Also, long-term complications may be associated with transfusion. Any potentially harmful delayed effects of transfusion must be balanced against the immediate mortality benefit from blood administration after surgical blood loss.
Abstract
Association Between Hospital Intraoperative Blood Transfusion Practices for Surgical Blood Loss and Hospital Surgical Mortality Rates
Wu WC, Trivedi A, Friedmann PD, et al
Ann Surg. 2012;255:708-714
Summary
Is there variation in transfusion rates for patients with significant blood loss? If so, are transfusion rates related to overall mortality? The authors examined transfusion practices in 46,608 patients who were at least 65 years of age and hospitalized in Veterans Affairs hospitals. Estimated blood loss was > 500 mL in all patients. The authors found significant variation in transfusion rates, which ranged from 10%-92%. There was a negative correlation between transfusion rates and 30-day hospital mortality: increasing the transfusion rate by 10% lowered the mortality rate by about 0.7% (95% confidence interval, 0.3%-1.1%).
Viewpoint
This large study found a surprising variation in institutional response to blood loss. Regression analysis suggested a moderately strong negative correlation between transfusion rate and mortality (r = -.31, P = <.01). This was not a randomized trial; therefore, other possible confounding factors may explain the results. Also, long-term complications may be associated with transfusion. Any potentially harmful delayed effects of transfusion must be balanced against the immediate mortality benefit from blood administration after surgical blood loss.
Abstract
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