Use of red blood cell transfusions in surgery.
BACKGROUND
Limited blood supplies necessitate the rational use of blood products. The aim of the present study was to provide a basis for audits of red cell usage in surgery by benchmarking common practice. Application of the data to the construction of a maximum surgical blood order schedule may be relevant for centres that perform a serological crossmatch or who collect autologous units.


METHODS
Data on surgical procedures identified by Commonwealth Medical Benefits Schedule item numbers, were collected retrospectively from theatre and blood bank records at the Royal Melbourne and Melbourne Private hospitals from May 1997 to April 1998. The percentage of procedures for which red cells were transfused, and the mean, median and range of units transfused for procedures with >/= 30% transfusion likelihood were identified.


RESULTS
Over 12 months, 266 surgical procedure codes were itemized >/= 10 times each, contributing 12 300 data entries. Only 38 procedures demonstrated an incidence of transfusion of at least 30%. Most frequently transfused procedures included spinal fusion, total hip replacement, mandible/maxilla resection, prostatectomy and bladder excision.


CONCLUSIONS
The number of common surgical procedures in which there is a 30% or greater likelihood that red cell transfusions will be given is limited. This benchmarking of common red cell usage is a first step in the process of determination of transfusion appropriateness.
Department of Diagnostic Haematology, Royal Melbourne Hospital, Parkville, Victoria, Australia. maxandjc@ozemail.com.au
Ellen L
EL
Maxwell
Jack
J
Metz
Michael N
MN
Haeusler
Helen F
HF
Savoia
D001315:Australia; D001771:Blood Banks / Q000592:standards / Q000706:statistics & numerical data; D001788:Blood Grouping and Crossmatching / Q000592:standards / Q000706:statistics & numerical data; D016063:Blood Loss, Surgical / Q000517:prevention & control / Q000706:statistics & numerical data; D001804:Blood Transfusion, Autologous / Q000592:standards / Q000706:statistics & numerical data; D017707:Erythrocyte Transfusion / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008485:Medical Audit / Q000592:standards / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000592:standards / Q000706:statistics & numerical data*