Over the last several years there has been increasing evidence that transfusions during surgery may be more harmful than helpful.
A new study (Glance 2011) looked at the impact of intraoperative transfusions on outcomes in patients undergoing noncardic surgery who had preoperative hemoglobins in the 6-10 g/dl range. Data came from the large, high quality American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP) database. Compared to patients not transfused, those transfused had higher mortality rates, as well as increased pulmonary complications, sepsis, thromboembolic complications, and wound complications.
Studies have also shown that anemia increases the morbidity and mortality from surgery. So to try to account for confounding factors, Glance et al decided to look at those patients with hemoglobins in the 6-10 g/dl range, where guidelines suggest decisions about transfusions be based on clinical grounds. They had to apply some fairly sophisticated regression models and adjustments to get good comparisons but those and the overall quality of data in this large database make the results striking. Mortality was 29% higher in those transfused and the increases in complications ranged from 43-87%. The authors discuss several potential theoretical mechanisms that might account for these detrimental effects of transfusions. But the bottom line is that, regardless of what the mechanism is, transfusions appear to result in worse outcomes in this patient population.
Though the authors call for a large randomized controlled trial to put the issue to rest, the accompanying editorial (Spahn 2011) says it is already time for a change in view of the mounting evidence of the detrimental effects of intraoperative transfusions.
Not only may a reduction in blood transfusions reduce complications, it may also save considerable amounts of money. A program at Loyola University Hospital reduced transfusion of blood products by 10% per patient and produced at net savings of over $450,000 (Loyola University Hospital 2010).
Glance LG, Dick AW, Mukamel DB, et al. Association between Intraoperative Blood Transfusion and Mortality and Morbidity in Patients Undergoing Noncardiac Surgery. Anesthesiology 2011; 114(2): 283-292
Spahn DR, Shander A, Hofmann A, Berman MF. More on Transfusion and Adverse Outcome: It's Time to Change. Anesthesiology 2011; 114(2): 234-236
Loyola University Health System. Reducing Blood Transfusions Improves Patient Safety and Cuts Costs. Newswise 10/7/2010