title: Ottawa Criteria for Appropriate Transfusions in Hepatectomy: Using the RAND/UCLA Appropriateness Method.
abstract: Create practice guidelines for the appropriate use of red blood cell transfusions in hepatectomy.
  
  
  
  Hepatectomy is associated with a high prevalence of transfusions. A transfusion can be life-saving, but can be associated with important adverse effects. Given the prevalence, the potential for benefit and harm, and the difficulty in conducting clinical trials, transfusion in hepatectomy is well-suited for a study of appropriateness.
  
  
  
  Using the RAND/UCLA appropriateness method, an international, multidisciplinary expert panel in hepatobiliary surgery, anesthesia, transfusion medicine, and critical care rated a series of 468 perioperative scenarios for transfusion appropriateness. Scenarios were rated individually, and again during an inperson group moderated session. Median scores and level of agreement were calculated to classify each scenario as appropriate, inappropriate, or uncertain.
  
  
  
  Approximately, 47.4% of scenarios were rated as appropriate for transfusion, 28.2% were inappropriate, and 24.4% were uncertain. The key recommendations for intraoperative transfusion were (i) it is never inappropriate to transfuse for significant bleeding or ST segment changes; (ii) it is never inappropriate to transfuse for an intraoperative hemoglobin ≤75 g/L; and (iii) in the absence of significant bleeding or ST changes, transfusion for hemoglobin of ≥95 g/L is inappropriate, and transfusion for hemoglobin of ≥85 g/L requires strong justification. The key recommendations for postoperative transfusions were: (i) in a stable, asymptomatic patient, an appropriate transfusion trigger is 70 g/L (without coronary artery disease) or 80 g/L (with coronary artery disease) and (ii) it is appropriate to transfuse any patient for a hemoglobin of ≤75 g/L either immediately post-operative, or with a significant decrease from the previous day (>15 g/L).
  
  
  
  Based on best available evidence and expert opinion, criteria for appropriate perioperative red blood cell transfusions in hepatectomy were determined.
authors.affiliation: Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.|The Ottawa Hospital, Ottawa, Ontario, Canada.|Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Sean
authors.initials: S
authors.lastname: Bennett
authors.affiliation: The Ottawa Hospital, Ottawa, Ontario, Canada.|Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Alan
authors.initials: A
authors.lastname: Tinmouth
authors.affiliation: The Ottawa Hospital, Ottawa, Ontario, Canada.|Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Daniel I
authors.initials: DI
authors.lastname: McIsaac
authors.affiliation: The Ottawa Hospital, Ottawa, Ontario, Canada.|Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Shane
authors.initials: S
authors.lastname: English
authors.affiliation: Department of Medicine, Centre hospitalier de l'Université de Montréal, Montréal, Quebec, Canada.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Hébert
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Karanicolas
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, Canada.|Centre de reserche du CHU de Québec, Population Health and Optimal Health Practices Research Unit (Trauma, Emergency, Critical Care Medicine), Université Laval, Québec, Canada.
authors.forename: Alexis F
authors.initials: AF
authors.lastname: Turgeon
authors.affiliation: Department of Surgery, McGill University, Montréal, Quebec, Canada.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Barkun
authors.affiliation: Department of Surgery, The Ohio State University, Columbus, OH.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
authors.affiliation: Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.|The Ottawa Hospital, Ottawa, Ontario, Canada.|Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Dean
authors.initials: D
authors.lastname: Fergusson
authors.affiliation: Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.|The Ottawa Hospital, Ottawa, Ontario, Canada.|Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Martel
mesh_terms: D000367:Age Factors; D016063:Blood Loss, Surgical; D002170:Canada; D000066491:Clinical Decision-Making; D003324:Coronary Artery Disease; D017707:Erythrocyte Transfusion; D019317:Evidence-Based Medicine; D006339:Heart Rate; D006439:Hemodynamics; D006452:Hemoglobinometry; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D007391:International Cooperation; D011183:Postoperative Complications / Q000628:therapy; D014481:United States