To formulate baseline thresholds for the initiation of RBC transfusion in elective surgical patients: an observational study at a tertiary care center

Abstract

Abstract:

Introduction:  A wide discrepancy exists in terms of transfusions in elective surgical procedures. An ‘evidence based’ institutional recommendations hence is needed to prevent procedure-based mortality. Objective: This present mixed cohort study was conducted at a tertiary health care center to propose a safe threshold for RBC transfusion in elective surgical patients.  Materials and Methods: Elective surgical patients (n=793) were categorized into 12 surgical groups and evaluated for pre-transfusion hemoglobin (Hb), red cell (RBC) units transfused, length of stay (LOS) and mortality.  Results: We analyzed significant differences within surgical subgroups as per objectives and survival, mortality comparisons using the Kaplan Meyer Log-rank survival curve KM(LR) for differences in evaluated parameters. We found that in elective surgical patients, malignancy and general surgeical patients had lower Hb than other groups. (p<0.05). There were significant differences in gender (male vs female) included Hb and LOS. Male patients had significant differences in survival with Hb >7.0g/dl compared to ≤ 7g/dl,KM (LR) (p < 0.05) and higher survival with Hb >7g/dl than ≤ 7g/dl after 15 days of hospital stay. In addition, increased RBC units usage was associated with lower survival but without significant survival benefit between 1U and >1U transfusion. Hb had a small effect size of only 0.6% in overall survival in patients. Conclusion: A Hb threshold of > 7g/dl is beneficial only after 7-15 days of hospital stay. An increase in RBC units does not provide a survival benefit. Hb level has an overall low ‘effect size’ in patient outcomes. Hb thresholds provide baseline data for evidence-based institutional surgical transfusion management.