Alvaro Tamayo-Velasco, J. V. Llau, María J. Colomina, Olga de la Varga-Martínez, R. Navarro-Pérez, Rocío López-Herrero, Jorge Almoguera-Fernández, Marta Alonso-Fernández, María Artiaga-Candia, Ángel Becerra‐Bolaños, Natalia Bugueño, Alma Casasempere-Sanus, Laura Contreras-López, María Heredia‐Rodríguez, I. de la Fuente-Graciani, Marta de la Rosa-Estadella, Iria de la Torre-Riveiro, Elena del Val-Peciña, Carla Delgado-Martí, Laura Edo-Cebollada, Ricardo Fernández-Fernández, Jorge Fernández-Rodríguez, Carolina Ferrer‐Gómez, Marta Giné-Servén, Almudena González-Pereira, A. Guereca-Gala, Aurora Herrera-Soto, M. E. Infantes-Morales, J. M. Marcos-Vidal, Gustavo Illodo-Miramontes, Adrián Martínez-López, A. Martínez Ruiz, Beatriz Martínez‐Rafael, Adrián Matute-González, Laura Pariente-Juste, Sonia Pérez González, Estefanía Gómez‐Pesquera, A Renedo-Fernández, A. A. Rodríguez-Álvarez, I. Sánchez-Rodríguez, María del Aranzazú Rodríguez-Conesa, Cristina Sánchez‐González, Cristina Tobar-Gonzalo, Lorena Varela-Rodríguez, R. Veloso-de Sousa, M. F. Muñoz-Moreno, J. I. García-Sánchez, Felipe Rocha-García, Pablo González-Montes, Patricia Cid-Boo, Gabriel Escudero-Gómez, Nekane Romero-García, Ana Cots, M. J. Peñarrubia-Ponce, Roberto Hornero, Eduardo Santamaría-Vázquez, Rodrigo Poves‐Álvarez, Eduardo Tamayo, Marina Varela-Durán, Rafael Badenes, DELPO Study Group
Despite a lower overall transfusion rate than international figures, nearly half of transfusions were inappropriate and transfusion omission, also represents a real clinical concern.
Background: Since their implementation in Spain, adherence of hospitals to Patient Blood Management (PBM) programs has been variable, potentially influencing transfusion practices. This study aimed to evaluate, in a real-world surgical setting, the frequency and appropriateness of red blood cell (RBC) transfusion. Methods: A prospective multicenter study in 43 Spanish hospitals including surgical patients. Transfusion appropriateness was evaluated using evidence-based criteria based on hemoglobin thresholds and clinical conditions such as cardiovascular disease, acute hemorrhage, or high comorbidity burden. Statistical analyses identified factors associated with transfusion practices. Results: The overall perioperative RBC transfusion rate was 9.7%, with the highest rates in cardiac (52.9%), vascular (17.9%), and orthopedic (12.3%) surgeries. RBC transfusion was associated with older patients with comorbidities, lower preoperative hemoglobin, higher ASA score and worse surgical meters and postoperative outcomes. Transfused patients showed significantly lower 60-day survival. Critically, 43% of transfusions were inappropriate, while transfusion omission (1.9%) may represent a clinical concern that warrants further investigation. Inappropriate transfusion was more frequent in older comorbidity patients according to Charlson Comorbidity Index in urgent surgery. In multivariable analysis, age was a factor associated with inappropriate transfusion, by cons, surgical blood loss was the main protective factor against inappropriate transfusion. Conclusion: As far as we know, this is the first Spanish multicenter study evaluating transfusion appropriateness in surgical scenario. Despite a lower overall transfusion rate than international figures, nearly half of transfusions were inappropriate and transfusion omission, also represents a real clinical concern. Implementation of decision-support tools and strengthened PBM protocols are needed to address factors associated with inappropriate transfusion, such as age, and to optimize patient safety and resource use.