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British Journal of Anaesthesia, 117 (5): 610–6 (2016)

Evaluation of clinical practice in perioperative patient blood management

D. M. Baron1, P. G. H. Metnitz2, T. Fellinger3, B. Metnitz4, A. Rhodes5 and S. A. Kozek-Langenecker6*

^{1 – Department of Anesthesia, General Intensive Care, and Pain Management, Medical University of Vienna, Vienna, Austria,}

^{2 – Department of General Anaesthesiology, Emergency and Intensive Care Medicine, Medical University of Graz, Graz, Austria,}

^{3 – Center for Medical Statistics, Informatics, and Intelligent Systems, Section for Medical Statistics, Medical University of Vienna, Vienna, Austria,}

^{4 – Austrian Center for Documentation and Quality Management in Intensive Care Medicine, Vienna, Austria,}

^{5 – Department of Intensive Care Medicine, St George’s University Hospitals NHS Foundation Trust, London, UK and}

^{6 – Department of Anaesthesia and Intensive Care, Evangelical Hospital Vienna, Vienna, Austria}

^{*Corresponding author. E-mail: sibylle.kozek@aon.at}

 

Background: Several guidelines have been published to facilitate implementation of patient blood management (PBM). This study was performed to evaluate clinical practices in PBM.

Methods: An online survey based on the guidelines for the management of severe perioperative bleeding from the European Society of Anaesthesiology (ESA) was conducted among ESA members. We assessed characteristic data of participating physicians, preoperative assessment of bleeding risk and anaemia, intraoperative transfusion practices, specific pharmacologic treatment of significant bleeding, and clinical use of PBM algorithms. Data distributions for five European regions and the workplace and experience of physicians were analysed using a v2 test.

Results: We received 706 fully completed surveys from physicians in 57 countries. Most (99%) respondents were anaesthetists or intensive care physicians, and 68% worked at university or university-affiliated hospitals. A standardised bleeding history before surgery is routinely obtained by 48% of physicians. When bleeding history is negative, 55% of physicians routinely order preoperative coagulation testing. Only 24% of physicians timely assess patients at risk of bleeding during surgery for anaemia before elective surgery. When anaemia is diagnosed, 38% of physicians routinely investigate its cause. The rate of routinely performed targeted haemostatic interventions with fibrinogen, vitamin K or prothrombin complex, and tranexamic acid was 60%, 52%, and 54%, respectively. Algorithms to guide PBM are used by 62% of physicians. Results varied between geographic regions.

Conclusions: Major deficits exist in the use of recommended PBM among anaesthetists, indicating an opportunity to improve clinical standards.

Key words: coagulation; patient blood management; perioperative period; surgery; transfusion

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