[Trends in autologous blood transfusion in the old states of the Federal Republic of Germany, 1989-1993. 1. A panel study of 143 hopitals].

Increased perception of the risks of homologous blood transfusion has focused substantial interest on autologous blood transfusion (ABT). To evaluate the role of ABT in the Federal Republic of Germany (FRG), we conducted postal surveys of German hospitals in 1989 and 1993. In the present study, the responses of 143 hospitals in the "old" federal states (former West Germany) that replied to both of our surveys were analysed. The objective was to examine trends in ABT practice in the FRG from 1989 to 1993. The study was restricted to the "old" federal states because data for the "new" federal states (former German Democratic Republic) were not available for that period. METHODS. Data presented in this study were obtained by postal surveys of German hospitals in 1989 and 1993. Because of German reunification (3 October 1990), only hospitals in the "old" federal states were surveyed in 1989, while hospitals in both the "old" and "new" states were included in 1993. Four hundred randomly selected hospitals in the "old" federal states were included in both surveys, 143 of which responded to both. The completed questionnaires of these 143 hospitals were analysed. In addition, to estimate the magnitude of positive selection bias, the data provided by these 143 hospitals were compared with data provided by another set of 162 hospitals in the "old" federal states that replied to the 1993 but not to the 1989 survey. RESULTS. There were no significant changes from 1989 to 1993 in the 143 hospitals with respect to hospital size by number of beds and spectrum of surgical specialties. The proportion of hospitals that performed preoperative autologous blood donation grew by 20% (from 74% to 89%) and the proportion that used this technique regularly ("frequently" and "mostly") rose by 80% (from 25% to 45%). The percentage of hospitals that performed preoperative plasmapheresis had more than doubled (from 8% to 19%). The proportion that used acute isovolaemic haemodilution grew by 32% (from 62% to 82%), while those doing so regularly ("frequently" and "mostly") increased by only 17% (from 23% to 27%). The fraction of hospitals equipped with cell-washing devices grew by 29% (from 35% to 45%). General transfusion practice, as measured by acceptance of postoperative haemoglobin levels of less than 10.0 g/dl, had changed but little. CONCLUSIONS. Although the 143 hospitals are not representative on a national level, the findings of our study allow some conclusions on general trends in the "old" states of the FRG. The potential for ABT has substantially grown in the "old" states from 1989 to 1993, although more consistent advantage of this potential could be taken.