Introduction
Perioperative transfusion is associated with reduced with reduced survival1 and increased
morbidity and mortality2 Several studies report poor adoption of guidelines and wide
variation in clinical practice3.
However, the influence of simple practical factors is disregarded, as for instance
which blood products are available in which time for the transfusing physician? We
hypothesize that local practical issues are a relevant cofounder of transfusion decisions.
Methods
With kind endorsement of EACTAIC, the link to a web-based survey was sent via newsletter
to all EACTAIC-Members via the monthly newsletter in November 2020.
Results
The Newsletter was opened by 429 active members. We collected 66 survey responses,
with 51 complete surveys, resulting in a response rate of 11.9%
72% of participants report having a local algorithm for the use of blood products
and coagulation factors. Several factors were reported as having an influence on the
local transfusion algorithm (Figure 1) and on transfusion practice (Figure 2).
86% of respondents report ROTEM®/TEG® available, 76% haemoglobin tests, 24% quick
measurements and 22% Thrombocyte function tests. 6% of the respondents have no point
of care test available.
A majority of respondents report the possibility to receive more than 10 labile blood
products delivered at once (64%). Packed red blood cells are available with a median
time delay of 10-15 minutes (Figure 3). For platelets, a median time between ordering
and delivery of 15-20 minutes was reported (Figure 4).
Discussion
The data of our survey reveals wide variability in the logistics of perioperative
transfusion and significant subjective influence of these logistic factors. The time
to delivery of labile blood products was the most mentioned factor. To our knowledge,
this is the first study to evaluate logistic factors with influence on transfusion
practice. The principal limitation of our survey is the low response rate. In many
situations, the transfusing physician has the consequences of a delayed or omitted
transfusion directly in sight, while the consequences of unnecessary transfusions
remain diffuse. Those subjective benefits of transfusion might lead to a risk-aversive
behavior, as is known from economy and sociology 4. In combination with (perceived)
long delivery times, this might be a contributing factor for transfusion incidence.
The adaption of institutional processes therefore bear potential benefits for better
adherence to transfusion guidelines.
In conclusion, transfusion logistics show wide variation across different institutions
and are a significant subjective contributor to the individual transfusion behaviour.
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© 2021 Published by Elsevier Inc.
