Study Calls Out Need for Blood Transfusion Guidelines

URMC research about the wide variation among physicians and hospitals for blood transfusions during colorectal surgery has triggered a “call to action” for protocols to clear up this long-debated area of medicine.

In the journal Diseases of the Colon and Rectum, lead author Christopher Aquina, M.D., a senior resident and research fellow in the Department of Surgery, and senior author Fergal Fleming, M.D., an assistant professor of Surgery who practices at the Wilmot Cancer Institute, report that transfusion rates before, during and after surgery range from 2.4 percent to 58.7 percent among surgeons, and from 2.9 percent to 32.8 percent among individual hospitals. They used a large, state-maintained database to conduct the retrospective study of more than 125,000 cases of colorectal surgeries between 2001 and 2013.

Even among the most experienced and high-volume surgeons, transfusion rates varied for unexplained reasons, the study said.

The findings raise two chief concerns, according to the authors.

First, perioperative blood transfusions have been strongly associated through prior research with post-operative infections such as pneumonia, sepsis, and surgical-site complications. In addition, the wide variations in practice suggest that surgeons need a better method of deciding when to use blood transfusions. An editorial in the journal that accompanies the study underlines these points.

Neil Blumberg, M.D., professor of Pathology and Laboratory Medicine at URMC, for more than 25 years has been investigating how to make blood transfusions safer and has been advocating locally, regionally, and nationally for fewer of them. He was a co-author on the current study. A year ago Blumberg also co-authored a study in the Journal of the American Medical Association showing that restricting transfusions reduces infection rates by nearly 20 percent.   

The current study’s findings “support the creation and implementation of perioperative blood transfusion protocols aimed at limiting unwarranted variation,” the authors concluded.

Fleming and Aquina are affiliated with URMC’s Surgical Health Outcomes & Research Enterprise (SHORE) team, which also includes study co-authors: Christian Probst, M.D., Adan Becerra, B.A., Bradley Hensley, M.D., Katia Noyes, Ph.D., and John R.T. Monson, M.D.