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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 6/2016

01-06-2016 | Original Article

Understanding Perioperative Transfusion Practices in Gastrointestinal Surgery—a Practice Survey of General Surgeons

Authors: Lavanya Yohanathan, Natalie G. Coburn, Robin S. McLeod, Daniel J. Kagedan, Emily Pearsall, Francis S. W. Zih, Jeannie Callum, Yulia Lin, Stuart McCluskey, Julie Hallet, for the Best Practices in General Surgery (BPIGS) group

Published in: Journal of Gastrointestinal Surgery | Issue 6/2016

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Abstract

Background

Despite guidelines recommending restrictive red blood cell transfusion (RBCT) strategies, perioperative transfusion practices still vary significantly. To understand the underlying mechanisms that lead to gaps in practice, we sought to assess the attitudes of surgeons regarding the perioperative management of anemia and use of RBCT in patients having gastrointestinal surgery.

Methods

We conducted a self-administered Web-based survey of general surgery staff and residents, in a network of eight academic institutions at the University of Toronto. We developed a questionnaire using a systematic approach of items generation and reduction. We tested face and content validity and test–retest reliability. We administered the survey via emails, with planned reminders.

Results

Total response rate was 48.1 % (62/125). Half (51.0 %) of respondents stated that they were unlikely to conduct a preoperative anemia work-up. About 54.0 % reported ordering preoperative oral iron supplementation for anemia. Most respondents indicated using a 70 g/L hemoglobin trigger (92.0 %) for transfusion. Factors increasing thresholds above 70 g/L included cardiac comorbidity (58.0 %), acute cardiac disease (94.0 %), symptomatic anemia (68.0 %), and suspected bleeding (58.0 %). With those factors, the transfusion threshold often increased above 90 g/L. Respondents perceived RBCTs to increase the postoperative morbidity (62 %), but not to impact the mortality (48 %) and cancer recurrence (52 %). Institutional protocols (68.0 %), blood conservation clinics (44.0 %), and clinical practice guidelines (84.0 %) were believed to encourage restrictive use of RBCTs.

Conclusion

Self-reported perioperative transfusion practices for GI surgery are heterogeneous. Few respondents investigated preoperative anemia. Stated use of RBCT indications varied from recommendations in published guidelines for patients with symptomatic anemia. Establishing team consensus and implementing local blood management guidelines appear necessary to improve uptake of evidence-based recommendations.
Appendix
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Metadata
Title
Understanding Perioperative Transfusion Practices in Gastrointestinal Surgery—a Practice Survey of General Surgeons
Authors
Lavanya Yohanathan
Natalie G. Coburn
Robin S. McLeod
Daniel J. Kagedan
Emily Pearsall
Francis S. W. Zih
Jeannie Callum
Yulia Lin
Stuart McCluskey
Julie Hallet
for the Best Practices in General Surgery (BPIGS) group
Publication date
01-06-2016
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 6/2016
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-016-3111-5

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