Assessment of Intraoperative Blood Transfusion Practices during Elective Surgeries in a Tertiary Care Hospital: A Prospective Cross-sectional Study

Abstract

Introduction: Blood transfusion remains the cornerstone of managing volume depletion and blood loss during surgeries. There are always patients and situations which clearly benefit from blood transfusion intraoperatively. Crystalloids and colloids cannot replace blood, as a substitute when the patient’s oxygen carrying capacity has been compromised. Anaemia in acute and chronic conditions is associated with increased risk of morbidity and mortality. Thus, blood transfusion has a very important role in the perioperative management of the patient. Aim: To ascertain the common indications for which anaesthesiologists start perioperative blood transfusion, the rates of intraoperative overtransfusion, and to assess the variation in the blood transfusion practices at the study Institution from standard guidelines. Materials and Methods: A prospective cross-sectional study was conducted on 168 patients patients operated at Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India, from February 2017 to July 2017. The patients were adult American Society of Anaesthesiologists Physical Status (ASAPS) I and II, undergoing elective surgeries and required transfused blood intraoperatively. Operating room anaesthesiologists completed a record form for each of the patient. The form included details of the patient like age, gender, weight, type and duration of surgery, preoperative haemoglobin (done within 48 hours preoperatively), intraoperative blood loss, fluids and blood, and blood products transfused intraoperatively. The postoperative Haemoglobin (Hb) levels (done between 6 hours24 hours postoperatively) were also recorded. Results: The study showed that, 76 out of the 168 (45.2%) patients, who were transfused blood intraoperatively had been overtransfused, i.e., their postoperative Hb values were more than 10 g/dL. Blood loss was the sole indication for transfusion in 41 out of 168 (24.4%) patients. Blood was transfused in patients with low preoperative Hb in 21/168 (12.5%) patients, while it was done on surgeon’s request in 13/168 (7.7%) cases. Pallor, hypovolaemia and haemodynamic instability as sole indications included only 4.8%, 2.4% and 1.2% cases, respectively. Conclusion: The present study revealed that a significant number (45.2%) of patients were overtransfused. A wide variation exists from the standard guidelines among anaesthesiologists. Implementation of restrictive transfusion strategies and a protocol-based intraoperative transfusion is required to optimise patient outcome.