Gender disparities in red blood cell transfusion in elective surgery: a post hoc multicentre cohort study

OBJECTIVES: A post hoc gender comparison of transfusion-related modifiable risk factors among patients undergoing elective surgery. SETTINGS: 23 Austrian centres randomly selected and stratified by region and level of care. PARTICIPANTS: We consecutively enrolled in total 6530 patients (3465 women a...

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Autores principales: Gombotz, Hans, Schreier, Günter, Neubauer, Sandra, Kastner, Peter, Hofmann, Axel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5168603/
https://www.ncbi.nlm.nih.gov/pubmed/27965248
http://dx.doi.org/10.1136/bmjopen-2016-012210
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author Gombotz, Hans
Schreier, Günter
Neubauer, Sandra
Kastner, Peter
Hofmann, Axel
author_facet Gombotz, Hans
Schreier, Günter
Neubauer, Sandra
Kastner, Peter
Hofmann, Axel
author_sort Gombotz, Hans
collection PubMed
description OBJECTIVES: A post hoc gender comparison of transfusion-related modifiable risk factors among patients undergoing elective surgery. SETTINGS: 23 Austrian centres randomly selected and stratified by region and level of care. PARTICIPANTS: We consecutively enrolled in total 6530 patients (3465 women and 3065 men); 1491 underwent coronary artery bypass graft (CABG) surgery, 2570 primary unilateral total hip replacement (THR) and 2469 primary unilateral total knee replacement (TKR). MAIN OUTCOME MEASURES: Primary outcome measures were the number of allogeneic and autologous red blood cell (RBC) units transfused (postoperative day 5 included) and differences in intraoperative and postoperative transfusion rate between men and women. Secondary outcomes included perioperative blood loss in transfused and non-transfused patients, volume of RBCs transfused, perioperative haemoglobin values and circulating red blood volume on postoperative day 5. RESULTS: In all surgical groups, the transfusion rate was significantly higher in women than in men (CABG 81 vs 49%, THR 46 vs 24% and TKR 37 vs 23%). In transfused patients, the absolute blood loss was higher among men in all surgical categories while the relative blood loss was higher among women in the CABG group (52.8 vs 47.8%) but comparable in orthopaedic surgery. The relative RBC volume transfused was significantly higher among women in all categories (CABG 40.0 vs 22.3; TKR 25.2 vs 20.2; THR 26.4 vs 20.8%). On postoperative day 5, the relative haemoglobin values and the relative circulating RBC volume were higher in women in all surgical categories. CONCLUSIONS: The higher transfusion rate and volume in women when compared with men in elective surgery can be explained by clinicians applying the same absolute transfusion thresholds irrespective of a patient's gender. This, together with the common use of a liberal transfusion strategy, leads to further overtransfusion in women.
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spelling pubmed-51686032016-12-22 Gender disparities in red blood cell transfusion in elective surgery: a post hoc multicentre cohort study Gombotz, Hans Schreier, Günter Neubauer, Sandra Kastner, Peter Hofmann, Axel BMJ Open Haematology (Incl Blood Transfusion) OBJECTIVES: A post hoc gender comparison of transfusion-related modifiable risk factors among patients undergoing elective surgery. SETTINGS: 23 Austrian centres randomly selected and stratified by region and level of care. PARTICIPANTS: We consecutively enrolled in total 6530 patients (3465 women and 3065 men); 1491 underwent coronary artery bypass graft (CABG) surgery, 2570 primary unilateral total hip replacement (THR) and 2469 primary unilateral total knee replacement (TKR). MAIN OUTCOME MEASURES: Primary outcome measures were the number of allogeneic and autologous red blood cell (RBC) units transfused (postoperative day 5 included) and differences in intraoperative and postoperative transfusion rate between men and women. Secondary outcomes included perioperative blood loss in transfused and non-transfused patients, volume of RBCs transfused, perioperative haemoglobin values and circulating red blood volume on postoperative day 5. RESULTS: In all surgical groups, the transfusion rate was significantly higher in women than in men (CABG 81 vs 49%, THR 46 vs 24% and TKR 37 vs 23%). In transfused patients, the absolute blood loss was higher among men in all surgical categories while the relative blood loss was higher among women in the CABG group (52.8 vs 47.8%) but comparable in orthopaedic surgery. The relative RBC volume transfused was significantly higher among women in all categories (CABG 40.0 vs 22.3; TKR 25.2 vs 20.2; THR 26.4 vs 20.8%). On postoperative day 5, the relative haemoglobin values and the relative circulating RBC volume were higher in women in all surgical categories. CONCLUSIONS: The higher transfusion rate and volume in women when compared with men in elective surgery can be explained by clinicians applying the same absolute transfusion thresholds irrespective of a patient's gender. This, together with the common use of a liberal transfusion strategy, leads to further overtransfusion in women. BMJ Publishing Group 2016-12-12 /pmc/articles/PMC5168603/ /pubmed/27965248 http://dx.doi.org/10.1136/bmjopen-2016-012210 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Haematology (Incl Blood Transfusion)
Gombotz, Hans
Schreier, Günter
Neubauer, Sandra
Kastner, Peter
Hofmann, Axel
Gender disparities in red blood cell transfusion in elective surgery: a post hoc multicentre cohort study
title Gender disparities in red blood cell transfusion in elective surgery: a post hoc multicentre cohort study
title_full Gender disparities in red blood cell transfusion in elective surgery: a post hoc multicentre cohort study
title_fullStr Gender disparities in red blood cell transfusion in elective surgery: a post hoc multicentre cohort study
title_full_unstemmed Gender disparities in red blood cell transfusion in elective surgery: a post hoc multicentre cohort study
title_short Gender disparities in red blood cell transfusion in elective surgery: a post hoc multicentre cohort study
title_sort gender disparities in red blood cell transfusion in elective surgery: a post hoc multicentre cohort study
topic Haematology (Incl Blood Transfusion)
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5168603/
https://www.ncbi.nlm.nih.gov/pubmed/27965248
http://dx.doi.org/10.1136/bmjopen-2016-012210
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