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Efficacy and safety of institution-wide restrictive blood transfusion protocol in gynecologic surgical patients

      Objectives

      The use of restrictive blood transfusion protocols has been well documented in specific patient populations, however there is little data in the field of gynecology. The objective of this study was to compare differences in blood transfusion rates and surgical complications before and after the implementation of a restrictive transfusion protocol. The target population included patients undergoing major abdominal surgery by both gynecologists and gynecologic oncologists at a university hospital.

      Materials and Methods

      On July 1, 2018, our institution implemented a restrictive blood transfusion protocol based on the American Association of Blood Banks guidelines, recommending against blood transfusion in hemodynamically stable patients when hemoglobin is above 7g/dL. This study was a quality improvement effort using a quasi-experimental design. Retrospective chart review was completed using an institutional surgical database in combination with the ACS National Surgery Quality Improvement Program to review patients undergoing major abdominal surgery by the gynecology and gynecologic oncology services 18 months prior to and post initiation of the transfusion protocol. Outcomes included number of patients, units transfused, and postoperative complication rates. Complications included operating room takebacks, infections, wound disruptions, pulmonary, renal, CNS, and cardiac complications, as well as DVTs, readmissions, and mortality.
      Descriptive statistics were collected. Surgical data, including wound class, route of surgery, pathology, length of surgery, and emergent status were also collected. Transfusion and postoperative complication data were then analyzed. Categorical variables were analyzed using chi-squared and Fisher’s exact tests. Continuous variables were analyzed using student t-tests. A clustered analysis was also completed to further examine the significance of surgical complications.

      Results

      A total of 739 patients were included. There were 290 people in the pre-protocol group and 449 patients in the post-protocol group. A similar number of patients received blood transfusions in both groups (9.3% vs. 10.6% p=0.57). However, significantly fewer units of blood were given post-protocol initiation (72 units vs. 52 units p=0.003). All postoperative complications were not significantly different between groups (p>0.05). When a clustered analysis was done of postoperative complications, the difference was still not significant (p>0.05).

      Conclusion

      We analyzed the efficacy and surgical complication rates of an institution-wide restrictive blood transfusion protocol in patients undergoing major abdominal gynecologic surgery for both benign and oncologic indications. The restrictive transfusion protocol was effective in decreasing the number of units of blood transfused without affecting postoperative complication rates in these patients.