Use of interventions to minimise perioperative allogeneic blood transfusion in Australia. A survey by the International Study of Perioperative Transfusion (ISPOT) Study Group.
OBJECTIVE
To investigate use of interventions to minimise need for perioperative transfusion of allogeneic blood in surgical units in Australia.


METHODS
Two questionnaire-based surveys of practice.


METHODS
All hospitals in Australia, 1996-1997.


METHODS
Survey 1: all Australian hospitals that have at least 50 beds and undertake surgery; Survey 2: surgical units identified as using the interventions.


METHODS
Reported rates of use of the various interventions (preoperative autologous donation, acute normovolaemic haemodilution [ANH], cell salvage, and drugs); use of guidelines; and perceptions about the appropriateness of current levels of use.


RESULTS
Survey 1 was returned by 349 of 400 hospitals (87%) and Survey 2 by 324 of 578 surgical units (56%). Preoperative autologous donation was most widely used (70% of hospitals), most commonly in units performing orthopaedic or vascular surgery (65% and 37%, respectively). Cell salvage and ANH were used by 27% and 24% of hospitals, respectively, most often in units performing cardiothoracic (40% and 44%, respectively) and vascular surgery (29% and 15%, respectively). These three interventions were used significantly more in private than in public hospitals (P < 0.05). Use of printed guidelines was uncommon. Respondents considered that autologous transfusion techniques should be used more widely because of their perceived efficacy and concerns about safety of allogeneic blood. Perceived barriers to greater use included lack of surgeon or physician interest, uncertain scheduling of surgery in public hospitals and cost (cell salvage). Drugs to minimise blood loss were used by fewer than 10% of hospitals.


CONCLUSIONS
Interventions to minimise the need for perioperative allogeneic blood transfusion (apart from drugs) are widely used in Australia. However, enthusiasm for intraoperative techniques of re-infusing autologous blood needs to be assessed against the evidence of their efficacy and cost-effectiveness.
Henry
D A
DA
Faculty of Medicine and Health Sciences, University of Newcastle. mddah@mail.newcastle.edu.au
Henderson
K M
KM
Fryer
J L
JL
Treloar
C J
CJ
McGrath
K M
KM
Deveridge
S F
SF
D001315:Australia; D001781:Blood Component Removal / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000706:statistics & numerical data; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006397:Hematinics / Q000627:therapeutic use; D006438:Hemodilution / Q000706:statistics & numerical data; D016304:Hospitals, Private / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D020380:Needs Assessment; D018579:Patient Selection; D019990:Perioperative Care / Q000379:methods*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D065227:Transfusion Reaction
D006397:Hematinics