title: Intraoperative transfusion practices in Europe.
abstract: BACKGROUND
  Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe.
  
  
  METHODS
  We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013.
  
  
  RESULTS
  The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl(-1) and increased to 9.8 (1.8) g dl(-1) after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2).
  
  
  CONCLUSIONS
  Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl(-1)), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold.
  
  
  BACKGROUND
  NCT 01604083.
authors.affiliation: Clinic of Anesthesiology and Intensive Care Medicine, Faculty of Medicine of the Kepler University Linz, Linz, Austria jens.meier@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Meier
authors.affiliation: Emergency Institute of Cardiovascular Disease, University Bucharest, Bucharest, Romania.
authors.forename: D
authors.initials: D
authors.lastname: Filipescu
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, EKH Evangelic Hospital Vienna, Vienna, Austria.
authors.forename: S
authors.initials: S
authors.lastname: Kozek-Langenecker
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Hospital Clínico Universitario de Valencia, Valencia, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Llau Pitarch
authors.affiliation: Department of Anesthesiology, Royal Free Hospital Hampstead NHS Trust, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Mallett
authors.affiliation: Clinical Epidemiology, Eberhard Karls University Tübingen, Tübingen, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Martus
authors.affiliation: Department of Anesthesiology & Intensive Care Medicine & Pain, Tel Aviv Medical Centre, Tel Aviv, Israel.
authors.forename: I
authors.initials: I
authors.lastname: Matot
mesh_terms: D001803:Blood Transfusion / Q000379:methods* / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005060:Europe; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007430:Intraoperative Care / Q000379:methods* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
keywords: anaemia; anesthesia; blood transfusion; surgery; transfusion trigger