title: Packed red blood cell transfusion after surgery: are we "overtranfusing" our patients?
abstract: BACKGROUND
  Data on the hemoglobin (Hb) after transfusion, or the "target," which reflects the "dose" of blood given are not well studied. We sought to examine the incidence and causes of "over transfusion" of red blood cells after surgery.
  
  
  METHODS
  Data on blood utilization including Hb triggers and targets were obtained for patients undergoing colorectal, pancreas, or liver surgery between 2010 and 2013.
  
  
  RESULTS
  A total of 2,905 patients were identified, of which 895 (31%) were transfused (median age 64, interquartile range: 53 to 72; 51% men; median American Society of Anesthesiologists class 3, interquartile range: 3-3; 51% pancreatic, 14% hepatobiliary, 21% colorectal, and 14% other). Among these, 512 (57%) were overtransfused (final Hb target after transfusion ≥9.0 g/dL). Among patients who were overtransfused, 171 (33%) were transfused at too high an initial trigger (>8.0 g/dL), whereas 304 (59%) had an appropriate trigger but received ≥2 packed red blood cell (PRBC) units, suggesting an opportunity to have transfused fewer units. There was significant variation in overtransfusion among surgeons (range 0% to 80%, P = .003).
  
  
  CONCLUSIONS
  Excess use of blood transfusion is common and was due to PRBC utilization for too high a transfusion trigger, as well as too many units transfused.
authors.affiliation: Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA.
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Lucas
authors.affiliation: Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA.
authors.forename: Aslam
authors.initials: A
authors.lastname: Ejaz
authors.affiliation: Division of Surgical Oncology, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street Blalock 665, Baltimore, MD 21287, USA.
authors.forename: Gaya
authors.initials: G
authors.lastname: Spolverato
authors.affiliation: Division of Surgical Oncology, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street Blalock 665, Baltimore, MD 21287, USA.
authors.forename: Yuhree
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Division of Surgical Oncology, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street Blalock 665, Baltimore, MD 21287, USA.
authors.forename: Faiz
authors.initials: F
authors.lastname: Gani
authors.affiliation: Department of Anesthesiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Frank
authors.affiliation: Division of Surgical Oncology, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street Blalock 665, Baltimore, MD 21287, USA. Electronic address: tpawlik1@jhmi.edu.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000379:methods; D003107:Colorectal Surgery / Q000009:adverse effects* / Q000379:methods; D016001:Confidence Intervals; D016208:Databases, Factual; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000473:pathology / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D014481:United States; D019564:Unnecessary Procedures
keywords: Outcomes; Overtransfusion; Target; Transfusion; Trigger