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ROUTINE PERIOPERATIVE TRANSFUSION DOES NOT IMPROVE OUTCOME.

Patients with hemoglobin levels below 10 g/dl or hematocrit below 0.30 after surgery are frequently given prophylactic transfusions. This retrospective cohort study examined the effect of perioperative transfusion on 30- and 90-day postoperative mortality in 8,787 elderly patients with hip fracture; the patients had undergone surgery at 20 different hospitals between 1983 and 1993.

Forty-two percent received a transfusion within the first week. Among 4,452 patients whose lowest postoperative (i.e., "trigger") hemoglobin was between 8.0 and 9.9 g/dl, 56 percent received transfusion, compared with 7 percent of those whose trigger hemoglobin was 10.0 g/dl or higher. There was no evidence of an association between transfusion and 30- or 90-day mortality in patients with a trigger hemoglobin of 8.0 g/dl or higher. Since 90.5 percent of those with a trigger hemoglobin lower than 8.0 g/dl received transfusion, it was impossible to discern whether transfusion was beneficial for these patients.

Comment: These data confirm prior research suggesting that routine use of transfusion in response to hemoglobin triggers of 8.0 g/dl or more is not beneficial.

— TH Lee

Published in Journal Watch General Medicine February 6, 1998

Citation(s):

Carson JL et al. Perioperative blood transfusion and postoperative mortality. JAMA 1998 Jan 21 279 199-205.

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