Gender disparities in red blood cell transfusion in elective surgery: a post hoc multicentre cohort study
MetadataShow full item record
Objectives: A post hoc gender comparison of transfusion-related modifiable risk factors among patients undergoing elective surgery. Settings: 23 Austrian centres randomly selected and stratified by region and level of care. Participants: We consecutively enrolled in total 6530 patients (3465 women and 3065 men); 1491 underwent coronary artery bypass graft (CABG) surgery, 2570 primary unilateral total hip replacement (THR) and 2469 primary unilateral total knee replacement (TKR).Main outcome measures: Primary outcome measures were the number of allogeneic and autologous red blood cell (RBC) units transfused (postoperative day 5 included) and differences in intraoperative and postoperative transfusion rate between men and women. Secondary outcomes included perioperative blood loss in transfused and non-transfused patients, volume of RBCs transfused, perioperative haemoglobin values and circulating red blood volume on postoperative day 5. Results: In all surgical groups, the transfusion rate was significantly higher in women than in men (CABG 81 vs 49%, THR 46 vs 24% and TKR 37 vs 23%). In transfused patients, the absolute blood loss was higher among men in all surgical categories while the relative blood loss was higher among women in the CABG group (52.8 vs 47.8%) but comparable in orthopaedic surgery. The relative RBC volume transfused was significantly higher among women in all categories (CABG 40.0 vs 22.3; TKR 25.2 vs 20.2; THR 26.4 vs 20.8%). On postoperative day 5, the relative haemoglobin values and the relative circulating RBC volume were higher in women in all surgical categories. Conclusions: The higher transfusion rate and volume in women when compared with men in elective surgery can be explained by clinicians applying the same absolute transfusion thresholds irrespective of a patient’s gender. This, together with the common use of a liberal transfusion strategy, leads to further overtransfusion in women.
Showing items related by title, author, creator and subject.
Gombotz, H.; Rehak, P.; Shander, A.; Hofmann, Axel (2014)Background: Five years after the first Austrian benchmark study demonstrated relatively high transfusion rate and an abundance of nonindicated transfusions in elective surgeries, this study was conducted to investigate ...
Sex differences in outcomes following isolated coronary artery bypass graft surgery in Australian patients: Analysis of the Australasian Society of Cardiac and Thoracic Surgeons cardiac surgery databaseSaxena, A.; Dinh, D.; Smith, J.; Shardey, G.; Reid, Christopher; Newcomb, A. (2012)Objectives: Women undergoing isolated coronary artery bypass graft (CABG) surgery have been previously shown to be at an independently increased risk for post-operative morbidity and mortality. The current study evaluates ...
Does patient gender affect outcomes after concomitant coronary artery bypass graft and aortic valve replacement? An Australian society of cardiac and thoracic surgeons database studySaxena, A.; Poh, C.; Dinh, D.; Reid, Christopher; Smith, J.; Shardey, G.; Newcomb, A. (2011)Objectives: Women undergoing isolated coronary artery bypass graft (CABG) surgery have been previously shown to be at an independently increased risk for post-operative morbidity and mortality. However, there are considerably ...