Gombotz Hans, Rehak Peter H, Shander Aryeh, Hofmann Axel
Department of Anesthesiology and Intensive Care, General Hospital Linz, Krankenhausstrasse 9, A-4020 Linz, Austria.
Transfusion. 2007 Aug;47(8):1468-80. doi: 10.1111/j.1537-2995.2007.01286.x.
Benchmarking transfusion activity may help to eliminate inappropriate use of blood products. The goal of this study was to measure and to compare the current transfusion practice and to identify predictors of transfusion in public hospitals to develop strategies to optimize transfusion practices.
This was a prospective observational study in 18 randomly selected public hospitals from April 2004 to February 2005. Primary outcome measures were the amount of intra- and postoperative blood components transfused and intercenter variability of transfusion rate. Secondary outcome measures were prevalence of preoperative anemia, calculated perioperative blood loss, and lowest measured perioperative hemoglobin (Hb) level.
Adult patients undergoing primary unilateral total hip replacement (THR, n = 1401), primary unilateral knee replacement (TKR, n = 1296), hemicolectomy (HECOC, n = 148), and coronary artery bypass graft (CABG) surgery (n = 777) were enrolled. Due to the small number, data of HECOC patients were not fully analyzed. In the remaining procedures, there was a large intercenter variability in the percentage of patients who received transfusions: THR 16 to 85 percent, TKR 12 to 87 percent, and CABG 37 to 63 percent. In the patients who received transfusions, the number of red blood cells (RBC) units transfused varied significantly. There was also a considerable intercenter variability in RBC loss. The prevalence of preoperative anemia was 19 percent and identical in both sexes. The incidence of preoperative anemia was three times higher in patients who received transfusions compared to those who did not.
This study demonstrates a high intercenter variability in RBC transfusions and RBC loss in standard surgical procedures. Whereas the variability in blood loss remains largely unexplained, the main predictors for allogeneic RBC transfusions are preoperative and nadir Hb and surgical RBC loss.
对输血活动进行基准评估可能有助于消除血液制品的不当使用。本研究的目的是衡量和比较当前的输血实践，并确定公立医院输血的预测因素，以制定优化输血实践的策略。
这是一项前瞻性观察性研究，于2004年4月至2005年2月在18家随机选择的公立医院进行。主要观察指标为术中及术后输注的血液成分量和输血率的中心间差异。次要观察指标为术前贫血的患病率、计算的围手术期失血量以及围手术期测得的最低血红蛋白（Hb）水平。
纳入了接受初次单侧全髋关节置换术（THR，n = 1401）、初次单侧膝关节置换术（TKR，n = 1296）、半结肠切除术（HECOC，n = 148）和冠状动脉搭桥术（CABG）（n = 777）的成年患者。由于数量较少，未对HECOC患者的数据进行全面分析。在其余手术中，接受输血的患者百分比存在较大的中心间差异：THR为16%至85%，TKR为12%至87%，CABG为37%至63%。在接受输血的患者中，输注的红细胞（RBC）单位数量差异显著。RBC损失也存在相当大的中心间差异。术前贫血的患病率为19%，男女相同。接受输血的患者术前贫血的发生率是未接受输血患者的三倍。
本研究表明，在标准手术中，RBC输血和RBC损失存在较高的中心间差异。虽然失血差异在很大程度上仍无法解释，但异体RBC输血的主要预测因素是术前和最低点Hb以及手术RBC损失。
