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A REVIEW OF PERIOPERATIVE BLOOD CONSERVATION PRACTICES IN CANADA.

Departments of Anaesthesia, Queen Elizabeth II Health Science Centre, Halifax, Nova Scotia, B3H 2Y9, Toronto General Hospital, University Health Network, Toronto, Ontario, M5G 2C4, Health Science Centre General Hospital, Winnipeg, Manitoba R3E 0Z3

INTRODUCTION

Concerns about the risks, cost, and availability of allogeneic blood transfusion (ABT) have heightened the interest in perioperative blood conservation. This interest led to the creation of our organisation, which is dedicated to improving the perioperative transfusion practice. As a first step towards achieving this goal, we collected detailed transfusion-related information on patients undergoing total hip or knee arthroplasty (THA or TKA) at seven Canadian hospitals from January to March 2001 in order to assess the current status of, and variations in, transfusion and blood conservation practices across Canada

METHODS

At each of the seven institutions, after obtaining institutional ethics approval, data were collected prospectively on all patients undergoing elective THA or TKA from January to March 2001, including patient demographics, baseline and discharge hemoglobin concentrations, blood conservation modalities used, blood products used, and postoperative course. We compared the rate of ABT and the use of blood conservation modalities among the hospitals using descriptive statistics and ANOVA. We used logistic regression analysis to determine if inter-hospital differences in the rate of ABT were due to patient variables.

RESULTS

Data were collected on 676 patients, of whom 137 received ABT (inter-hospital range 7-33%, P<0.05). Forty-one percent of patients were anemic (Hb # 130 g/L) preoperatively. The average discharge Hb was 99 ± 13 g/L (range 93-103 g/L, P<0.05). Oral iron was the most widely used blood conservation modality (43%), followed by autologous blood donation (18%). Other modalities were rarely used: erythropoietin = 2%; acute normovolemic hemodilution, cell saver, and intravenous iron <1%). Four variables – preoperative anemia, older age, not collecting autologous blood, and having the operation at two of the institutions – increased the risk of transfusion (P<0.05 in logistic regression analysis, model c-index = 0.775).

DISCUSSION

The rate of ABT still varies widely among Canadian hospitals, and this variability is not completely explained by patient variables. In addition, many of the available blood conservation modalities are severely underused (e.g., only 14 of 272 anemic patients received erythropoietin). More attention needs to be paid to perioperative blood conservation to ensure that patients have access to appropriate blood conservation modalities and are not exposed to unnecessary transfusions.

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