Transfusion thresholds in common elective surgical procedures in Finland.
OBJECTIVE
Transfusion practices and thresholds in common elective surgical procedures were investigated in a nationwide multicenter survey in Finland.


METHODS
The records of 764 total hip replacement (THR), 397 total knee replacement (TKR) and 343 transurethral resection of the prostate (TURP) patients were reviewed by four anesthesiologists.


RESULTS
The allogeneic red cell (RBC) transfusion rates in THR, TKR and TURP operations were 92, 84 and 18%, respectively. In THR and TKR, 74% of patients who lost 20% or less of their blood volume during hospitalization were transfused with RBCs. Postoperatively, the median pretransfusion hemoglobin values were 9.6 g/dl in orthopedic operations and 10.7 g/dl in TURP. In some hospitals, the median transfusion threshold in TURP patients was as high as 11.2 g/dl.


CONCLUSIONS
The transfusion thresholds in all operations were liberal compared to recent international recommendations. Inappropriate thresholds were reflected in the high transfusion rates. This study accentuates the need for continuous discussion and educational measures to find optimal indications for transfusion in surgery, and to rationalize the transfusion policy in Finland.
Capraro
L
L
Finnish Red Cross Blood Transfusion Service, Helsinki, Finland. leena.capraro@bts.redcross.fi
Nuutinen
L
L
Myllylä
G
G
D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D016063:Blood Loss, Surgical; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D017707:Erythrocyte Transfusion / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D005387:Finland; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000601:surgery; D013534:Survival; D020728:Transurethral Resection of Prostate
D006454:Hemoglobins