Ottawa Criteria for Appropriate Transfusions in Hepatectomy: Using the RAND/UCLA Appropriateness Method.
Ann Surg
; 267(4): 766-774, 2018 04.
Article
em En
| MEDLINE
| ID: mdl-28288056
ABSTRACT
OBJECTIVE:
Create practice guidelines for the appropriate use of red blood cell transfusions in hepatectomy.BACKGROUND:
Hepatectomy is associated with a high prevalence of transfusions. A transfusion can be life-saving, but can be associated with important adverse effects. Given the prevalence, the potential for benefit and harm, and the difficulty in conducting clinical trials, transfusion in hepatectomy is well-suited for a study of appropriateness.METHODS:
Using the RAND/UCLA appropriateness method, an international, multidisciplinary expert panel in hepatobiliary surgery, anesthesia, transfusion medicine, and critical care rated a series of 468 perioperative scenarios for transfusion appropriateness. Scenarios were rated individually, and again during an inperson group moderated session. Median scores and level of agreement were calculated to classify each scenario as appropriate, inappropriate, or uncertain.RESULTS:
Approximately, 47.4% of scenarios were rated as appropriate for transfusion, 28.2% were inappropriate, and 24.4% were uncertain. The key recommendations for intraoperative transfusion were (i) it is never inappropriate to transfuse for significant bleeding or ST segment changes; (ii) it is never inappropriate to transfuse for an intraoperative hemoglobin ≤75âg/L; and (iii) in the absence of significant bleeding or ST changes, transfusion for hemoglobin of ≥95âg/L is inappropriate, and transfusion for hemoglobin of ≥85âg/L requires strong justification. The key recommendations for postoperative transfusions were (i) in a stable, asymptomatic patient, an appropriate transfusion trigger is 70âg/L (without coronary artery disease) or 80âg/L (with coronary artery disease) and (ii) it is appropriate to transfuse any patient for a hemoglobin of ≤75âg/L either immediately post-operative, or with a significant decrease from the previous day (>15âg/L).CONCLUSIONS:
Based on best available evidence and expert opinion, criteria for appropriate perioperative red blood cell transfusions in hepatectomy were determined.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Perda Sanguínea Cirúrgica
/
Guias de Prática Clínica como Assunto
/
Transfusão de Eritrócitos
/
Hepatectomia
Tipo de estudo:
Guideline
/
Prognostic_studies
/
Risk_factors_studies
/
Systematic_reviews
Limite:
Humans
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Ann Surg
Ano de publicação:
2018
Tipo de documento:
Article
País de afiliação:
Canadá