Les pratiques transfusionnelles chez les anesthésiologistes canadiens : une enquête

  • Alexis F. Turgeon
  • Dean A. Fergusson
  • Steve Doucette
  • Madhu Priya Khanna
  • Alan Tinmouth
  • Ashique Aziz
  • Paul C. Hébert
Article

Red blood cell transfusion practices amongst Canadian anesthesiologists: a survey

Abstract

Purpose

To assess red blood cell transfusion practices among Canadian anesthesiologists.

Methods

A survey depicting three realistic clinical scenarios of elective surgical procedures with different risks of bleeding was administered to all Canadian practicing members (n = 2,100) of the Canadian Anesthesiologists’ Society. Respondents were requested to choose hemoglobin thresholds for which they would transfuse red blood cells under various conditions within each scenario.

Results

We obtained a response rate of 47% (719/1,512). Transfusion thresholds differed significantly between baseline scenarios. A threshold above 70 g·L-1 was chosen by 48% of respondents in the general surgery scenario compared to 56% in the orthopedic surgery scenario and 79% in the vascular surgery scenario (P < 0.001). A history of coronary artery disease was associated with a transfusion threshold ≥ 100 g·L-1 in a significant proportion of respondents ranging from 20% in the orthopedic surgery scenario to 31% in the general surgery scenario and to 49% in the vascular surgery scenario (P < 0.001). Conversely, changing the patientx2019;s age from 60 to 20 yr resulted in the adoption of a transfusion threshold ≥ 60 g·L-1 by > 30% of respondents in two scenarios (P < 0.001). The year of respondent graduation was strongly associated with these findings.

Conclusion

There was significant variation in transfusion practices among Canadian anesthesiologists. The type of surgical procedure, patient’s age and a history of coronary artery disease influenced reported transfusion threshold. Practice variation in specific subgroups would support the need for further research to identify optimal transfusion thresholds.

Abstract

Objectif

Évaluer les pratiques transfusionnelles de culots globulaires chez les anesthésiologistes canadiens.

Méthode

Une enquête illustrant trois scénarios cliniques réalistes ďinterventions chirurgicales réglées comportant différents risques de saignement a été présentée aux membres canadiens en exercice (n = 2 100) de la Société canadienne des anesthésiologistes. Les répondants devaient choisir les seuils ďhémoglobine pour lesquels ils transfuseraient des culots globulaires selon diverses conditions à ľintérieur de chaque scénario.

Résultats

Le taux de réponse a été de 47 % (719/1 512). Les seuils de transfusion différaient significativement entre les scénarios de base. Un seuil de plus de 70 g·L-1 a été choisi par 48 % des répondants dans le scénario de chirurgie générale comparé à 56 % en chirurgie orthopédique et 79 % en chirurgie vasculaire (P < 0,001). Une histoire de cardiopathie ischémique a été associée à un seuil de transfusion ≥ 100 g·L-1 chez un nombre significatif de répondants, allant de 20 % pour le scénario de chirurgie orthopédique jusqu’à 31 % pour la chirurgie générale et à 49 % pour la cardiochirurgie (P > 0,001). À ľinverse, la modification de ľâge du patient, de 60 à 20 ans, a amené ľadoption ďun seuil de transfusion ≤ 60 g·L-1 par > 30 % des répondants pour deux scénarios (P < 0,001). Le nombre ďannées de pratique a fortement influencé ces résultats.

Conclusion

Il y a une variabilité significative de pratiques transfusionnelles chez les anesthésiologistes canadiens. Le type de chirurgie, ľâge du patient et une histoire de cardiopathie ischémique influencent le seuil de transfusion choisi. La diversité de la pratique de sous-groupes spécifiques renforce la nécessité de rechercher à ľavenir des seuils de transfusion optimaux.

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Copyright information

©  General Anesthesia 2006

Authors and Affiliations

  • Alexis F. Turgeon
    • 1
  • Dean A. Fergusson
    • 2
  • Steve Doucette
    • 2
  • Madhu Priya Khanna
    • 3
  • Alan Tinmouth
    • 2
    • 4
  • Ashique Aziz
    • 2
  • Paul C. Hébert
    • 2
    • 5
  1. 1.Critical Care Medicine ProgramUniversity of OttawaOttawaCanada
  2. 2.Centre for Transfusion and Critical Care Research, Clinical Epidemiology ProgramUniversity of OttawaOttawaCanada
  3. 3.Centre for Transfusion and Critical Care Research; Program of UrologyUniversity of OttawaOttawaCanada
  4. 4.Departments of HematologyUniversity of OttawaOttawaCanada
  5. 5.Critical Care MedicineUniversity of OttawaOttawaCanada
  6. 6.Centre for Transfusion and Critical Care Research, Clinical Epidemiology Program,Ottawa Health Research Institute, General CampusOttawaCanada

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