The second Austrian benchmark study for blood use in elective surgery: results and practice change

Abstract

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 the effects of the first benchmark study. Study Design and Methods: Data from 3164 patients undergoing primary unilateral total hip replacement (THR), primary unilateral noncemented total knee replacement (TKR), or coronary artery bypass graft (CABG) surgery at 15 orthopedic and six cardiac centers were collected and compared with the first study. Results: Transfusion rates decreased in THR (41% to 30%) and TKR (41% to 25%), but remained unchanged in CABG surgery (57% vs. 55%) compared with the first study. More than 80% of all transfusions involved at least 2 units of red blood cells (RBCs). Marked variations were observed in transfusion rates among the centers. The prevalence of anemia was three times higher in patients who received transfusions versus those who did not. However, preoperative anemia was left untreated in the majority of patients. A considerable intercenter variability of RBC loss ranging from 26% to 43% in THR, from 24% to 40% in TKR, and from 30% to 49% in CABG procedures was observed. Conclusion: The second benchmark study demonstrates substantial intercenter variability and small but significant reductions in RBC transfusions and RBC loss. Even though the main independent predictors of transfusion were the relative lost RBC volume followed by the relative preoperative and the lowest relative postoperative hemoglobin, preoperative anemia was not adequately treated in many patients, underscoring the importance of patient blood management in these patients.