title: The ongoing variability in blood transfusion practices in cardiac surgery.
abstract: BACKGROUND
  Although blood utilization has been under considerable scrutiny for the past two decades, particularly for surgery, studies comparing perioperative blood transfusion practices between countries are rare, and the evolution of international standards remains unknown. Therefore, the objective of this evaluation was to compare the perioperative transfusion of blood components in cardiac surgery in multiple centers in different countries.
  
  
  METHODS
  Transfusion practice was investigated prospectively in 70 centers among 16 countries. A total of 5065 randomly selected cardiac surgery patients of the Multicenter Study of Perioperative Ischemia Epidemiology II (EPI II) Study were evaluated. Utilization of red blood cells (RBCs), fresh-frozen plasma (FFP), and platelets (PLTs) was assessed daily, before, during, and after surgery until hospital discharge.
  
  
  RESULTS
  Intraoperative RBC transfusion varied from 9 to 100 percent among the 16 countries, and 25 to 87 percent postoperatively (percentage of transfused patients). Similarly, frequency of transfusion of FFP varied from 0 to 98 percent intraoperatively and 3 to 95 percent postoperatively, and PLT transfusion from 0 to 51 and 0 to 39 percent, respectively. Moreover, there were not only marked differences in transfusion rates between centers in different countries but also in interinstitutional comparison of multiple centers within countries.
  
  
  CONCLUSIONS
  In cardiac surgical patients, marked variability in transfusion practice exists between centers in various countries and suggests differences in perioperative practice patterns as well as possible inappropriate use. International standardization of perioperative practice patterns as well as transfusion regimes appears necessary.
authors.affiliation: Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany. diane@iref.org
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Snyder-Ramos
authors.forename: Patrick
authors.initials: P
authors.lastname: Möhnle
authors.forename: Yi-Shin
authors.initials: YS
authors.lastname: Weng
authors.forename: Bernd W
authors.initials: BW
authors.lastname: Böttiger
authors.forename: Alexander
authors.initials: A
authors.lastname: Kulier
authors.forename: Jack
authors.initials: J
authors.lastname: Levin
authors.forename: Dennis T
authors.initials: DT
authors.lastname: Mangano
mesh_terms: D000368:Aged; D001803:Blood Transfusion / Q000379:methods* / Q000706:statistics & numerical data; D017707:Erythrocyte Transfusion / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010949:Plasma; D017713:Platelet Transfusion / Q000379:methods / Q000706:statistics & numerical data; D013903:Thoracic Surgery