Original Research

Safety and Effectiveness of Reduced Red Blood Cells Consumption in Spine Surgery under the Guidance of West China Perioperative Transfusion Score (WCPTS): A Prospective, Randomized, Controlled Trial

Ren Liao , Hao-Rui Sun , Jin Liu , Shi-Mei Huai , Hong Zheng
Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China, Department of Anesthesiology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
J Anesth Perioper Med 2015; 2(3): 117- 125 . Published on May 1, 2015 . doi:10.24015/JAPM.2015.0017
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Abstract

Background: Transfusion trigger and target for surgical patients with hemoglobin (Hb) level between 7-10 per deciliter is not available worldwide, and the decision of whether red blood cells (RBCs) should be administered in these patients is made according to the experience of clinicians without evidences. Based on the physiology of the balance between oxygen supply and consumption, we suggested West China Perioperative Transfusion Score (WCPTS) to be safely applied to the patients undergoing spine surgery with effective reduction of RBCs transfusion.

Methods: We enrolled patients who were aged 15 to 70 years undergoing elective spine surgery with the expected blood loss more than 800 ml or 20% of the patient's whole blood volume. We randomly assigned patients to the WCPTS group (transfusion threshold under guidance of WCPTS) or the liberal-strategy group (transfusion threshold of 10 per deciliter). The primary outcomes were the proportion of patients who received RBCs transfusion and the units of transfused RBCs.

Results: The proportion of patients who received RBCs transfusion in the WCPTS group was significantly lower than that in the liberal-strategy group at all observed time periods (intraoperative: 24.0% vs. 88.2%, P<0.001; postoperative: 18.8% vs. 44.7%, P<0.001; perioperative: 36.5% vs. 89.4%, P<0.001). A median of zero units of RBCs were transfused in the WCPTS group and 3.5 units in the liberal-strategy group during perioperative period (P<0.001). The frequencies of in-hospital complication did not differ significantly between the two groups (P>0.05), and there were no significant between-group differences in length of stay in hospital, length of stay after operation, stitches removal time, time to normal life, and time to work in the two groups (P>0.05).

Conclusions: An objective evaluation of the status of oxygen supply and consumption could be achieved by application of WCPTS for patients with Hb level between 7-10 g/dl, and RBCs transfusion trigger and target could be determined on the basis of the evaluation, thus requirement of RBCs transfusion could be reduced by more than 70% under the guidance of WCPTS safely and effectively.

 

 

Citation:  Ren Liao, Hao-Rui Sun, Jin Liu, Shi-Mei Huai, Hong Zheng. Safety and effectiveness of reduced red blood cells consumption in spine surgery under the guidance of West China Perioperative Transfusion Score (WCPTS): a prospective, randomized, controlled trial. J Anesth Perioper Med 2015; 2: 117-25. doi: 10.24015/JAPM.2015.0017
 
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