1 Department of Surgery, Kuopio University Hospital, Kuopio, Finland.
2 School of Medicine, University of Eastern Finland, Kuopio, Finland.
Scand J Surg. 2019 Sep;108(3):210-215. doi: 10.1177/1457496918812207. Epub 2018 Nov 21.
Despite guidelines on blood transfusion (TF) thresholds, there seems to be great variation in transfusion policies between hospitals and surgeons. In order to improve and unify blood transfusion policies, the Finnish Red Cross Blood Service carried out a project concerning the optimal use of blood products (Verivalmisteiden optimaalinen käyttö) between 2002 and 2011. In this study, we determined the blood transfusion trends in major pancreatic surgery in Finland.
Initially, 1337 patients who underwent major pancreatic resections between 2002 and 2011 were classified into the TF+ or TF- groups. Centers were divided into high-, medium-, and low-volume centers. The blood transfusion trends and the trigger points for blood transfusions in these patients were determined.
There were no differences between high-, medium- and low-volume centers in blood usage, trigger points or the use of reserved blood units after pancreatoduodenectomy or total pancreatectomy. However, the trigger points were lowered significantly during the study period at high-volume centers (p = 0.003), and a better use of reserved blood units was found in high- (p < 0.001) and medium-volume (p = 0.043) centers. In addition, a better use of reserved blood units was found in high-volume centers after distal pancreatectomy (p = 0.020).
Although only minor changes in blood transfusion trends after pancreatoduodenectomy or total pancreatectomy were found generally, the lowering of the transfusion trigger point and the best use of reserved blood units during the study period occurred in high-volume centers.
尽管有输血（TF）阈值指南，但医院和外科医生之间的输血政策似乎存在很大差异。为了改进和统一输血政策，芬兰红十字会血液服务中心在 2002 年至 2011 年期间开展了一个关于优化血液制品使用的项目（Verivalmisteiden optimaalinen käyttö）。在这项研究中，我们确定了芬兰大型胰腺手术的输血趋势。
最初，将 2002 年至 2011 年间接受大型胰腺切除术的 1337 名患者分为 TF+或 TF-组。中心分为高、中、低容量中心。确定了这些患者的输血趋势和输血触发点。
在胰十二指肠切除术或全胰切除术之后，高、中、低容量中心之间在血液使用量、触发点或储备血液单位的使用方面没有差异。然而，在研究期间，高容量中心的触发点显著降低（p=0.003），并且在高（p<0.001）和中（p=0.043）容量中心中发现了更好的储备血液单位的使用。此外，在胰体尾切除术之后，高容量中心中也发现了更好的储备血液单位的使用（p=0.020）。
尽管一般来说，胰十二指肠切除术或全胰切除术之后的输血趋势只有较小的变化，但在研究期间，在高容量中心发生了输血触发点的降低和储备血液单位的最佳使用。
