PT  - JOURNAL ARTICLE
AU  - Andrew Medvecz
AU  - Andrew Bernard
AU  - Courtney Hamilton
AU  - Kevin M Schuster
AU  - Oscar Guillamondegui
AU  - Daniel Davenport
TI  - Transfusion rates in emergency general surgery: high but modifiable
AID  - 10.1136/tsaco-2019-000371
DP  - 2020 Feb 01
TA  - Trauma Surgery & Acute Care Open
PG  - e000371
VI  - 5
IP  - 1
4099  - http://tsaco.bmj.com/content/5/1/e000371.short
4100  - http://tsaco.bmj.com/content/5/1/e000371.full
SO  - Trauma Surg Acute Care Open2020 Feb 01; 5
AB  - Background Transfusion of red blood cells (RBC) increases morbidity and mortality, and emergency general surgery (EGS) cases have increased risk for transfusion and complication given case complexity and patient acuity. Transfusion reduction strategies and blood-conservation technology have been developed to decrease transfusions. This study explores whether transfusion rates in EGS have decreased as these new strategies have been implemented.Methods This is a retrospective review of the American College of Surgeons’ National Surgical Quality Improvement Program (ACS NSQIP) data from three academic medical centers. Operations performed by general surgeons on adults (aged ≥18 years) were selected. Data were analyzed from two periods: 2011–2013 and 2014–2016. Cases were grouped by the first four digits of the primary procedure Current Procedural Terminology code. Transfusion was defined as any RBC transfusion during or within 72 hours following the operation. Composite morbidity was defined as any NSQIP complication within 30 days following the operation.Results Overall general surgery transfusion rates decreased from 6.4% to 4.8% from period 1 to period 2 (emergent: 16.6%–11.5%; non-emergent 4.9%–3.7%; Fisher’s exact p values <0.001). Among patients transfused, the number of units received decreased slightly (median 2 U (IQR 2–3) to median 2 U (IQR 1–3), Mann-Whitney U test p=0.005). Morbidity decreased (overall: 13.8%–12.3%, p=0.001; emergent: 26.3%–20.6%, p<0.001) while mortality did not change.Discussion Rates of RBC transfusion decreased in both emergent and non-emergent cases. Efforts to reduce transfusion may have been successful in the EGS population. Morbidity improved over the time periods while mortality was unchanged.Level of Evidence Level III.