title: Understanding Perioperative Transfusion Practices in Gastrointestinal Surgery-a Practice Survey of General Surgeons.
abstract: Despite guidelines recommending restrictive red blood cell transfusion (RBCT) strategies, perioperative transfusion practices still vary significantly. To understand the underlying mechanisms that lead to gaps in practice, we sought to assess the attitudes of surgeons regarding the perioperative management of anemia and use of RBCT in patients having gastrointestinal surgery.
  
  
  
  We conducted a self-administered Web-based survey of general surgery staff and residents, in a network of eight academic institutions at the University of Toronto. We developed a questionnaire using a systematic approach of items generation and reduction. We tested face and content validity and test-retest reliability. We administered the survey via emails, with planned reminders.
  
  
  
  Total response rate was 48.1 % (62/125). Half (51.0 %) of respondents stated that they were unlikely to conduct a preoperative anemia work-up. About 54.0 % reported ordering preoperative oral iron supplementation for anemia. Most respondents indicated using a 70 g/L hemoglobin trigger (92.0 %) for transfusion. Factors increasing thresholds above 70 g/L included cardiac comorbidity (58.0 %), acute cardiac disease (94.0 %), symptomatic anemia (68.0 %), and suspected bleeding (58.0 %). With those factors, the transfusion threshold often increased above 90 g/L. Respondents perceived RBCTs to increase the postoperative morbidity (62 %), but not to impact the mortality (48 %) and cancer recurrence (52 %). Institutional protocols (68.0 %), blood conservation clinics (44.0 %), and clinical practice guidelines (84.0 %) were believed to encourage restrictive use of RBCTs.
  
  
  
  Self-reported perioperative transfusion practices for GI surgery are heterogeneous. Few respondents investigated preoperative anemia. Stated use of RBCT indications varied from recommendations in published guidelines for patients with symptomatic anemia. Establishing team consensus and implementing local blood management guidelines appear necessary to improve uptake of evidence-based recommendations.
authors.affiliation: Division of General Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Lavanya
authors.initials: L
authors.lastname: Yohanathan
authors.affiliation: Division of General Surgery, University of Toronto, Toronto, ON, Canada.|Division of General Surgery, Odette Cancer Centre-Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: Natalie G
authors.initials: NG
authors.lastname: Coburn
authors.affiliation: Division of General Surgery, University of Toronto, Toronto, ON, Canada.|Division of General Surgery, Mount Sinai Hospital, Toronto, ON, Canada.
authors.forename: Robin S
authors.initials: RS
authors.lastname: McLeod
authors.affiliation: Division of General Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Kagedan
authors.affiliation: Division of General Surgery, Mount Sinai Hospital, Toronto, ON, Canada.
authors.forename: Emily
authors.initials: E
authors.lastname: Pearsall
authors.affiliation: Division of General Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Francis S W
authors.initials: FS
authors.lastname: Zih
authors.affiliation: Department of Clinical Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.|Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
authors.forename: Jeannie
authors.initials: J
authors.lastname: Callum
authors.affiliation: Department of Clinical Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.|Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
authors.forename: Yulia
authors.initials: Y
authors.lastname: Lin
authors.affiliation: Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada.
authors.forename: Stuart
authors.initials: S
authors.lastname: McCluskey
authors.affiliation: Division of General Surgery, University of Toronto, Toronto, ON, Canada. julie.hallet@sunnybrook.ca.|Division of General Surgery, Odette Cancer Centre-Sunnybrook Health Sciences Centre, Toronto, ON, Canada. julie.hallet@sunnybrook.ca.|Odette Cancer Centre-Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, T2-063, Toronto, M4N3M5, ON, Canada. julie.hallet@sunnybrook.ca.
authors.forename: Julie
authors.initials: J
authors.lastname: Hallet
mesh_terms: D000740:Anemia / Q000097:blood / Q000628:therapy*; D001291:Attitude of Health Personnel; D013505:Digestive System Surgical Procedures; D017707:Erythrocyte Transfusion; D013502:General Surgery; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007396:Internship and Residency; D008505:Medical Staff, Hospital; D059035:Perioperative Period; D010818:Practice Patterns, Physicians'; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires
chemical_list: D006454:Hemoglobins
keywords: Anemia; Blood; Gastrointestinal; Red blood cell; Surgery; Transfusion