Investigation of the Transfusion Practices in Surgical Patients in Turkey

Study Overview
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Brief Summary
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The aim of this study is to describe the transfusion practices in patients undergoing major surgery in Turkey. The transfusion rates of red blood cells (RBC), fresh frozen plasma (FFP) and platelets; the transfusion predictors and transfusion related patient outcomes are investigated.

Detailed Description
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Patient Blood Management (PBM) is an evidence based multidisciplinary approach for the care of patients who may need blood transfusion. The aim of PBM is achieving better patient outcomes by focusing on the patients' own blood as a source. To date PBM is considered good transfusion practice and is being implemented in a growing number of countries. The Turkish Society of Anesthesiologists PBM Task Force is working on this subject since 4 years and decided to conduct a study. Before starting a PBM program, the transfusion practices of clinicians working at diverse surgical fields; differences between current transfusion practices and PBM strategies; the areas for improvement and the obstacles that could prevent change could be identified with this study. Data collection will also serve to identify the current situation as a reference and to control the achievement of the PBM's aim: improving clinical outcomes. These data will be refered as The Turkish National Perioperative Transfusion Study (TULIP TS) data. The aim of this study is to describe the transfusion practices in patients undergoing major surgery in Turkey. The study evaluates i. The perioperative transfusion rates of RBCs, FFP and platelets. ii. With which reasons the anesthesiologists decide to transfuse a patient (co morbidities of the patients, physiologic transfusion triggers, hemoglobin trigger, uncontrolled bleeding, on request from surgeon etc.). iii. The relation of transfusion and the patients co-morbidity index, the P POSSUM score and SORT score; anesthesia methods; monitorisation methods (hemodynamic, coagulation); amount of bleeding; type of surgery; type of hospital. iv. The relation of transfusion and patient outcomes (unanticipated ICU admission, prolonged ICU stay, acute renal failure, thromboembolic events, ischemic events, pulmonary complications, cardiac advers events, infections, acute respiratory distress, infection, all-cause mortality).

Official Title
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Investigation of the Transfusion Practices in Surgical Patients in Turkey

Conditions
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Surgery, Blood Loss, Surgical, Blood Loss Anemia, Blood Transfusion, Anemia, Coagulation Disorder

Intervention / Treatment
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* Other: Blood transfusion


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients undergoing major elective surgery Exclusion Criteria: Trauma patients, emergency surgery
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Other: Blood transfusion|Transfusion of blood products in the perioperative period in patients undergoing major surgery|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Preoperative amount of blood products transfused | Preoperative amount of blood products: RBCs,FFP and platelets transfused | Before surgery at day 0 | 
| Intraoperative amount of blood products transfused | Intraoperative amount of blood products: RBC's,FFP and platelets transfused | During surgery at day 0 | 
| Postoperative amount of blood products transfused | Postoperative amount of blood products: RBCs,FFP and platelets transfused | 24 hours after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Preoperative transfusion indications | The reasons to decide to transfuse (factors determining transfusion) blood products | Before surgery at day 0 | 
| Intraoperative transfusion indications | The reasons to decide to transfuse (factors determining transfusion) blood products | During surgery at day 1 | 
| Postoperative transfusion indications | The reasons to decide to transfuse (factors determining transfusion) blood products | 24 hours after surgery | 
| Unanticipated ICU admission | Whether the patient had an unanticipated ICU admission | After surgery at day 1 | 
| Prolonged length of stay in ICU | Whether the patient had a prolonged length of stay in ICU | After surgery at day 2 | 
| Acute renal failure | Whether the patient had acute renal failure | After surgery at day 2 | 
| Thromboembolic event | Whether the patient had a thromboembolic event concerning lungs (pulmonary embolism), brain (stroke), gastrointestinal tract, kidneys, or extremities etc. | After surgery at day 2 | 
| Ischemic event | Whether the patient had an ischemic event concerning heart, nervous system,limb, gastrointestinal tract etc. | After surgery at day 2 | 
| Infection | Whether the patient had infection: wound, pneumonia, urinary, sepsis etc. | After surgery at day 2 | 
| Acute respiratory distress | Whether the patient had acute respiratory distress | After surgery at day 2 | 
| Mortality | Whether the patient died: all cause mortality | after surgery at day 30 | 
| Preoperative anemia | Whether the patient had anemia (Hemoglobin male < 13 female < 12 g/dL) | Before surgery at day 0 | 
| Preoperative coagulopathy | Whether the patient had coagulopathy due to disease or drugs | Before surgery at day 0 | 
| Pretransfusion hemoglobin values | The hemoglobin concentration before transfusion | Before surgery at day 0 | 
| Pretransfusion hemoglobin values | The hemoglobin concentration before transfusion | During surgery at day 1 | 
| Pretransfusion hemoglobin values | The hemoglobin concentration before transfusion | After surgery at day 2 | 
| Advers cardiac events | Whether the patient had an advers cardiac event: myocardial infaction; non fatal cardiac arest; arrhytmia; cardiogenic pulmonary edema etc | After surgery at day 30 |