The use of technologies to decrease peri-operative allogenic blood transfusion: results of practice variation in Israel.
BACKGROUND
Concern about the side effects of allogeneic blood transfusion has led to increased interest in methods of minimizing peri-operative transfusion. Technologies to minimize allogeneic transfusion include drugs such as aprotinin, desmopressin, tranexamic acid and erythropoietin, and techniques such as acute normovolemic hemodilution, cell salvage and autologous pre-donation.


OBJECTIVE
To survey the current use in Israel of these seven technologies to minimize allogeneic blood transfusion.


METHODS
Our survey was conducted in 1996-97 in all hospitals in Israel with more than 50 beds and at least one of the following departments: cardiac or vascular surgery, orthopedics, or urology. All departments surveyed were asked: a) whether the technologies were currently being used or not, b) the degree of use, and c) the factors influencing their use and non-use. The survey was targeted at the heads of these departments.


RESULTS
Pharmaceuticals to reduce allogeneic blood transfusion were used in a much higher proportion in cardiac surgery departments than in the other three departments. Pre-operative blood donation was used in few of the cardiac, urologic and vascular surgery departments compared to its moderate use in orthopedic departments. The use of acute normovolemic hemodilution was reported in a majority of the cardiac departments only. Moderate use of cell salvage was reported in all departments except urology where it was not used at all.


CONCLUSIONS
There is considerable practice variation in the use of technologies to minimize exposure to peri-operative allogeneic blood transfusion in Israel.
Katz
E
E
Department of Anesthesia, Bnai Zion Medical Center, Haifa, Israel. edna_k@netvision.net.il
Gaitini
L
L
Samri
M
M
Egoz
N
N
Fergusson
D
D
Laupacis
A
A
D007611:Aprotinin / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D020811:Biomedical Technology; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000379:methods*; D001804:Blood Transfusion, Autologous; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D003625:Data Collection; D004921:Erythropoietin / Q000627:therapeutic use; D006438:Hemodilution; D006490:Hemostatics / Q000627:therapeutic use; D006761:Hospitals; D006801:Humans; D007557:Israel; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods; D019990:Perioperative Care / Q000009:adverse effects* / Q000379:methods*; D010818:Practice Patterns, Physicians'; D016879:Salvage Therapy; D014148:Tranexamic Acid / Q000627:therapeutic use; D065227:Transfusion Reaction; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods
D006490:Hemostatics; D004921:Erythropoietin; D014148:Tranexamic Acid; D007611:Aprotinin