A Simple Guideline Reduces the Need for Red Blood Cell Transfusions in Swiss Hospitals: A Prospective, Multicentre, Before-and-After Study in Elective Hip and Knee Replacement

Fontana, Stefano; de la Cuadra, Ana Cristina; Müller, Beatrice Ursula; Schmid, Pirmin; Perler, Gosia; Luginbühl, Martin; Mansouri Taleghani, Behrouz (2014). A Simple Guideline Reduces the Need for Red Blood Cell Transfusions in Swiss Hospitals: A Prospective, Multicentre, Before-and-After Study in Elective Hip and Knee Replacement. Transfusion medicine and hemotherapy, 41(3), pp. 182-188. Karger 10.1159/000363540

[img] Text
Perler_M_Transfusion.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (163kB) | Request a copy

INTRODUCTION Optimising the use of blood has become a core task of transfusion medicine. Because no general guidelines are available in Switzerland, we analysed the effects of the introduction of a guideline on red blood cell (RBC) transfusion for elective orthopaedic surgery. METHODS Prospective, multicentre, before-and-after study comparing the use of RBCs in adult elective hip or knee replacement before and after the implementation of a guideline in 10 Swiss hospitals, developed together with all participants. RESULTS We included 2,134 patients, 1,238 in 7 months before, 896 in 6 months after intervention. 57 (34 or 2.7% before, 23 or 2.6% after) were lost before follow-up visit. The mean number of transfused RBC units decreased from 0.5 to 0.4 per patient (0.1, 95% CI 0.08-0.2; p = 0.014), the proportion of transfused patients from 20.9% to 16.9% (4%, 95% C.I. 0.7-7.4%; p = 0.02), and the pre-transfusion haemoglobin from 82.6 to 78.2 g/l (4.4 g/l, 95% C. I. 2.15-6.62 g/l, p < 0.001). We did not observe any statistically significant changes in in-hospital mortality (0.4% vs. 0%) and morbidity (4.1% vs. 4.0%), median hospital length of stay (9 vs. 9 days), follow-up mortality (0.4% vs. 0.2%) and follow-up morbidity (6.9% vs. 6.0%). CONCLUSIONS The introduction of a simple transfusion guideline reduces and standardises the use of RBCs by decreasing the haemoglobin transfusion trigger, without negative effects on the patient outcome. Local support, training, and monitoring of the effects are requirements for programmes optimising the use of blood.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Haematology and Central Haematological Laboratory
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute for Evaluative Research into Orthopaedic Surgery
04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine

UniBE Contributor:

Fontana, Stefano; de la Cuadra, Ana Cristina; Müller, Beatrice Ursula; Perler, Gosia; Luginbühl, Martin and Mansouri Taleghani, Behrouz

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1660-3796

Publisher:

Karger

Language:

English

Submitter:

Jeannie Wurz

Date Deposited:

20 Mar 2015 13:50

Last Modified:

23 Jan 2018 12:15

Publisher DOI:

10.1159/000363540

PubMed ID:

25053931

Uncontrolled Keywords:

Guideline, Red blood cells, Surgery Transfusion

BORIS DOI:

10.7892/boris.65996

URI:

https://boris.unibe.ch/id/eprint/65996

Actions (login required)

Edit item Edit item
Provide Feedback