Packed red blood cell transfusion after surgery: are we “overtranfusing” our patients?

• The current study examined the incidence of “over transfusion” after surgery.
• A hemoglobin level ≥9.0 g/dL after red cell transfusion was defined as an “overtransfusion.”
• Among transfused patients 57% were overtransfused.
• Risk factors for overtransfusion included a trigger ≥8.0 g/dL and transfusion of multiple units.

BackgroundData 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.MethodsData on blood utilization including Hb triggers and targets were obtained for patients undergoing colorectal, pancreas, or liver surgery between 2010 and 2013.ResultsA 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).ConclusionsExcess 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.