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A survey of surgical transfusion practice in Europe

Objective

The main aims of the project were to assess the use of and the reasons for the use of blood, blood products and artificial colloids, by scrutinizing a sample of elective surgical procedures in 43 teaching hospitals of 10 European countries. Furthermore, the assessment was intended to cover a gap in the specific supranational study was yet available, and notable variations among countries are observed in blood self-sufficiency, organisation and financing of transfusion services, prevalence of viral infectious disease transmission, and in the costs.
In order to improve the quality of transfusion in elective surgery, the Concerted Action on the safe and good use of blood in surgery (SANGUIS) was established. It assessed how much, when, and why blood, blood components, blood derivatives, and artificial colloids were used in 6 common surgical procedures: cholecystectomy, colectomy, abdominal aortic aneurysectomy, total hip replacement, aortocoronary bypass, and transurethral prostatectomy. The project totalled 8118 patients in 43 university hospitals and 10 countries. Data were collected in both surgical units and transfusion services. The study has revealed large variations in the use of individual blood components, autologous blood, blood derivatives, and artificial colloids, even within the same country. In red cell transfusion, for instance, the hospital was the major predictive factor, alongside patient haematological data. Many hospitals provided only scant data on the reasons for transfusion, and discrepancies were noted in the transfusion information recorded by surgical units and transfusion services. The results of data analysis will be redistributed to participating clinicians, providing a basis for discussion and improvement.
Blood is a natural resource and hence limited, exaustable, and costly. In clinical practice blood transfusion is a not replaceable support; however blood transfusion carries besides benefits also risks, including those of viral disease transmission. Although in the last decade a number of strategies have been promoted to enhance the safety of blood transfusion, a comparable improvement in the clinical use of blood and components, accompanied by an evaluation of the patient outcome in relation to varying transfusion regimes is less documented. In fact, inappropriateness in the clinical use of blood and interhospital variability for the same patient category are documented, although results of consensus development conferences and guidelines for clinical audit have been published. In blood transfusion, as for other clinical fields, the main issues still open to debate include the need for a more complete scientific knowledge on the transfusion indications, the identification and implementation of means whereb effectively translating the scientific knowledge into practice, the assessment and improvement of the clinical transfusion practice and the evaluation of the patient outcome in relation to the transfusion regimen given.

Funding Scheme

CON - Coordination of research actions

Coordinator

Centro Trasfusionale e di Immunologia dei Trapianti
Address
Via Francesco Sforza 35
20122 Milano
Italy