Adjusted transfusion triggers improve transfusion practice in orthopaedic surgery
Although blood transfusion has never been safer, there remains concern about adverse effects. We designed guidelines, the 6‐8‐10‐Flexinorm, based on the conditions which are relevant to the decision to transfuse. To evaluate these new guidelines, we performed a case–control study in patients undergo...
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| Published in: | Transfusion medicine (Oxford, England) Vol. 15; no. 1; pp. 13 - 18 |
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| Main Authors: | , , , , , , |
| Format: | Journal Article |
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Oxford, UK; Malden, USA
Blackwell Science Ltd
01-02-2005
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| Abstract | Although blood transfusion has never been safer, there remains concern about adverse effects. We designed guidelines, the 6‐8‐10‐Flexinorm, based on the conditions which are relevant to the decision to transfuse. To evaluate these new guidelines, we performed a case–control study in patients undergoing elective primary total hip replacement. The study consisted of two parts. In the first part, physicians were strongly encouraged to use the new guidelines; in the second part, only registration took place. During the first and second part of the study, the use of packed red cells (PRC) in Hospital A (study hospital) decreased from 1·1 ± 1·5 to 0·6 ± 1·2 and 0·3 ± 0·9 units, whereas in Hospital B (control), the use of PRC remained unchanged (1 ± 1·5, 1 ± 1·7 and 1 ± 2 units). In the prestudy groups, 43% of the patients in Hospital A were transfused compared to 45% in Hospital B. In the first and second part of the study, 27%, respectively, 14% of the patients in Hospital A were transfused compared to 40% in both periods in Hospital B. The new guidelines lead to a reduction in the use of allogeneic blood and a decrease in the number of patients transfused. |
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| AbstractList | Although blood transfusion has never been safer, there remains concern about adverse effects. We designed guidelines, the 6‐8‐10‐Flexinorm, based on the conditions which are relevant to the decision to transfuse. To evaluate these new guidelines, we performed a case–control study in patients undergoing elective primary total hip replacement. The study consisted of two parts. In the first part, physicians were strongly encouraged to use the new guidelines; in the second part, only registration took place. During the first and second part of the study, the use of packed red cells (PRC) in Hospital A (study hospital) decreased from 1·1 ± 1·5 to 0·6 ± 1·2 and 0·3 ± 0·9 units, whereas in Hospital B (control), the use of PRC remained unchanged (1 ± 1·5, 1 ± 1·7 and 1 ± 2 units). In the prestudy groups, 43% of the patients in Hospital A were transfused compared to 45% in Hospital B. In the first and second part of the study, 27%, respectively, 14% of the patients in Hospital A were transfused compared to 40% in both periods in Hospital B. The new guidelines lead to a reduction in the use of allogeneic blood and a decrease in the number of patients transfused. Although blood transfusion has never been safer, there remains concern about adverse effects. We designed guidelines, the 6-8-10-Flexinorm, based on the conditions which are relevant to the decision to transfuse. To evaluate these new guidelines, we performed a case-control study in patients undergoing elective primary total hip replacement. The study consisted of two parts. In the first part, physicians were strongly encouraged to use the new guidelines; in the second part, only registration took place. During the first and second part of the study, the use of packed red cells (PRC) in Hospital A (study hospital) decreased from 1.1 +/- 1.5 to 0.6 +/- 1.2 and 0.3 +/- 0.9 units, whereas in Hospital B (control), the use of PRC remained unchanged (1 +/- 1.5, 1 +/- 1.7 and 1 +/- 2 units). In the prestudy groups, 43% of the patients in Hospital A were transfused compared to 45% in Hospital B. In the first and second part of the study, 27%, respectively, 14% of the patients in Hospital A were transfused compared to 40% in both periods in Hospital B. The new guidelines lead to a reduction in the use of allogeneic blood and a decrease in the number of patients transfused. |
| Author | Van Raaij, J. J. A. M. Eindhoven, G. B. Hagenaars, J. A. M. Diercks, R. L. Richardson, F. J. De Wolf, J. Th. M. Van Horn, J. R. |
| Author_xml | – sequence: 1 givenname: G. B. surname: Eindhoven fullname: Eindhoven, G. B. organization: Department of Anaesthesiology – sequence: 2 givenname: R. L. surname: Diercks fullname: Diercks, R. L. organization: Department of Orthopaedic Surgery, University Hospital – sequence: 3 givenname: F. J. surname: Richardson fullname: Richardson, F. J. organization: Department of Anaesthesiology – sequence: 4 givenname: J. J. A. M. surname: Van Raaij fullname: Van Raaij, J. J. A. M. organization: Department of Orthopaedic Surgery, Martini Hospital, and – sequence: 5 givenname: J. A. M. surname: Hagenaars fullname: Hagenaars, J. A. M. organization: Department of Anaesthesiology – sequence: 6 givenname: J. R. surname: Van Horn fullname: Van Horn, J. R. organization: Department of Orthopaedic Surgery, University Hospital – sequence: 7 givenname: J. Th. M. surname: De Wolf fullname: De Wolf, J. Th. M. email: j.th.m.de.wolf@int.azg.nl organization: Department of Haematology, University Hospital, Groningen, The Netherlands |
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| Cites_doi | 10.1046/j.1365-2141.2001.02701.x 10.1111/j.1399-6576.1989.tb02972.x 10.1056/NEJM199902113400606 10.1056/NEJM199902113400601 10.1097/00003246-198706000-00001 10.1097/00000542-199802000-00009 10.1097/00000542-199603000-00032 10.7326/0003-4819-116-5-403 10.1046/j.1365-2346.1997.00084.x 10.1093/bja/73.6.857 10.1001/jama.1961.03040420001001 10.1001/jama.260.18.2700 10.1111/j.1365-3148.1994.tb00262.x 10.7326/0003-4819-116-5-393 10.1097/00003246-199705000-00004 10.1046/j.1365-2346.2001.00883.x 10.1001/jama.269.23.3024 |
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| References_xml | – volume: 14 start-page: 35 issue: SS‐1 year: 1997 end-page: 37 article-title: Measurement of blood loss in clinical studies publication-title: European Journal of Anaesthesiology – volume: 73 start-page: 857 year: 1994 end-page: 859 article-title: Consensus statement on red cell transfusion publication-title: British Journal of Anaesthesia – volume: 269 start-page: 3024 year: 1993 end-page: 3029 article-title: Effect of stored blood transfusion on oxygen delivery in patients with sepsis publication-title: The Journal of the American Medical Association – volume: 4 start-page: 251 year: 1994 end-page: 268 article-title: Use of blood products for elective surgery in 43 European hospitals publication-title: Transfusion Medicine – volume: 340 start-page: 409 year: 1999 end-page: 417 article-title: A multicenter, randomized, controlled clinical trial of transfusion requirement in critical care publication-title: The New England Journal of Medicine – volume: 33 start-page: 588 year: 1989 end-page: 592 article-title: Coagulation and fibrinolytic parameters in patients undergoing total hip replacement: influence of the anesthesia technique publication-title: Acta Anaesthesiologica Scandinavica – volume: 116 start-page: 393 year: 1992 end-page: 402 article-title: Prudent strategies for elective red blood cell transfusion publication-title: Annals of Internal Medicine – volume: 88 start-page: 327 year: 1998 end-page: 333 article-title: Variability in transfusion practice for coronary artery bypass surgery persist despite national consensus guidelines. A 24‐institution study publication-title: Anesthesiology – volume: 178 start-page: 261 year: 1961 end-page: 266 article-title: The role of anesthesia in surgical mortality publication-title: The Journal of the American Medical Association – volume: 84 start-page: 732 year: 1996 end-page: 747 article-title: Practice guidelines for Blood Component Therapy publication-title: Anesthesiology – volume: 21 start-page: 335 year: 1999 end-page: 339 article-title: Erythrocytes stored in CPD SAG‐mannitol: evaluation of their deformability publication-title: Clinical Hemorheology and Microcirculation – volume: 156 start-page: S9 issue: II Suppl. year: 1997 end-page: S26 article-title: Review of the clinical practice literature on allogeneic red blood cell transfusion publication-title: Canadian Medical Association Journal – volume: 18 start-page: 495 year: 2001 end-page: 498 article-title: Transfusion strategy publication-title: European Journal of Anaesthesiology – volume: 260 start-page: 2700 year: 1988 end-page: 2703 article-title: Consensus conference, National Institutes of Health publication-title: The Journal of the American Medical Association – volume: 340 start-page: 438 year: 1999 end-page: 448 article-title: Medical progress: Transfusion Medicine (first of two parts) – Blood Transfusion publication-title: The New England Journal of Medicine – volume: 113 start-page: 24 year: 2001 end-page: 31 article-title: Guidelines for the clinical use of red cell transfusions publication-title: British Journal of Haematology – volume: 25 start-page: 726 year: 1997 end-page: 732 article-title: Transfusing red blood cells stored in citrate phosphate dextrose adenine‐1 for 28 days fails to improve tissue oxygenation in rats publication-title: Critical Care Medicine – volume: 116 start-page: 403 year: 1992 end-page: 405 article-title: Practice strategies for elective red blood cell transfusion publication-title: Annals of Internal Medicine – volume: 15 start-page: 545 year: 1987 end-page: 550 article-title: Acute phase protein response to tissue injury publication-title: Critical Care Medicine – ident: e_1_2_6_4_1 doi: 10.1046/j.1365-2141.2001.02701.x – ident: e_1_2_6_5_1 doi: 10.1111/j.1399-6576.1989.tb02972.x – ident: e_1_2_6_9_1 doi: 10.1056/NEJM199902113400606 – ident: e_1_2_6_11_1 doi: 10.1056/NEJM199902113400601 – volume: 21 start-page: 335 year: 1999 ident: e_1_2_6_12_1 article-title: Erythrocytes stored in CPD SAG‐mannitol: evaluation of their deformability publication-title: Clinical Hemorheology and Microcirculation contributor: fullname: Izzo P. – volume: 156 start-page: S9 year: 1997 ident: e_1_2_6_10_1 article-title: Review of the clinical practice literature on allogeneic red blood cell transfusion publication-title: Canadian Medical Association Journal contributor: fullname: Hebert P.C. – ident: e_1_2_6_16_1 doi: 10.1097/00003246-198706000-00001 – ident: e_1_2_6_17_1 doi: 10.1097/00000542-199802000-00009 – ident: e_1_2_6_3_1 doi: 10.1097/00000542-199603000-00032 – ident: e_1_2_6_2_1 doi: 10.7326/0003-4819-116-5-403 – ident: e_1_2_6_8_1 doi: 10.1046/j.1365-2346.1997.00084.x – ident: e_1_2_6_15_1 doi: 10.1093/bja/73.6.857 – ident: e_1_2_6_6_1 doi: 10.1001/jama.1961.03040420001001 – ident: e_1_2_6_14_1 doi: 10.1001/jama.260.18.2700 – ident: e_1_2_6_18_1 doi: 10.1111/j.1365-3148.1994.tb00262.x – ident: e_1_2_6_20_1 doi: 10.7326/0003-4819-116-5-393 – ident: e_1_2_6_7_1 doi: 10.1097/00003246-199705000-00004 – ident: e_1_2_6_19_1 doi: 10.1046/j.1365-2346.2001.00883.x – ident: e_1_2_6_13_1 doi: 10.1001/jama.269.23.3024 |
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| SubjectTerms | Aged Arthroplasty, Replacement, Hip - standards Blood Loss, Surgical - prevention & control blood transfusion Blood Transfusion, Autologous - standards Elective Surgical Procedures - standards Erythrocyte Transfusion - standards Female guidelines Humans Male Middle Aged orthopaedic surgery Practice Guidelines as Topic - standards transfusion triggers |
| Title | Adjusted transfusion triggers improve transfusion practice in orthopaedic surgery |
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