AUTOLOGOUS BLOOD-TRANSFUSION IN THE FEDER AL-REPUBLIC-OF-GERMANY - RESULTS OF A 1993 QUESTIONNAIRE .2. THE USE OF AUTOLOGOUS BLOOD-TRANSFUSION IN THE OLD AND NEW STATES OF THE FEDERAL-REPUBLIC-OF-GERMANY AFTERREUNIFICATION

In 1993, we conducted a postal survey to assess the use of autologous blood transfusion (ABT) in the Federal Republic of Germany after reuni fication. The results of this survey have already been reported in a p revious paper, but without differentiation between the ''old'' and ''n ew'' states (former West Germany and former German Democratic Republic , respectively). In the present study, the data of our 1993 survey wer e further analysed to see if there were differences in the use of ABT between the ''old'' and ''new'' states. Methods. The study is based on data of a 1993 postal survey of German hospitals. Details concerning the performance of the survey have been reported in a previous paper. Briefly, questionnaires were mailed to the anaesthesia departments of 400 randomly selected hospitals in the ''old'' states and 284 hospital s in the ''new'' states of the Federal Republic of Germany. The questi onnaires contained 36 questions related to general information on the hospital and the use of ABT; 305 completed questionnaires were returne d from the ''old'' states and 197 from the ''new'' states, response ra tes of 76% and 69%, respectively. For the present investigation, the: responses of the hospitals of the ''old'' and ''new'' states were anal ysed separately. Frequency distributions of categorical variables were analysed by the chi-square test. Because of multiple testing, statist ical significance was attained only at the 0.05% level (P less than or equal to 0.0005). Results. There were no significant differences betw een the ''old'' and ''new'' states with respect to hospital size by nu mber of beds, percentage of general and specialised hospitals, and per centage of operations requiring blood transfusion. In both the ''old'' and ''new'' states, 9% of the responding hospitals maintained a hospi tal-based transfusion service, while the other depended on regional bl ood banks. Preoperative autologous blood donation (PABD) was performed at least ''rarely'' in 85% and 71% (P = 0.0001), and ''mostly'' in 20 % and 10% (P = 0.0014) of the hospitals in the ''old'' and ''new'' sta tes, respectively. Uniformly, the principal uses of PABD were for orth opaedic and cardiac surgery. In 62% and 27% (P < 0.0001) of those hosp itals that reported performing PABD, the autologous blood service was run by the anaesthesia department. Preoperative plasmapheresis was per formed in 14% and 8% (P = 0.008), and isovolaemic haemodilution in 82% and 56% (P < 0.0001) of the hospitals in the ''old'' and ''new'' stat es, respectively. Automated autotransfusion devices (cell savers) were available in 38% and 19% (P < 0.0001) of the hospitals, respectively. Simple collection devices for perioperative blood salvage were used i n 17% and 15% (P = 0.24) of the hospitals in the ''old'' and ''new'' s tates, respectively. Conclusion. We conclude that ABT is more widely u sed in the ''old'' than the ''new'' states of the Federal Republic of Germany. ABT is regarded as a desirable alternative to homologous bloo d transfusion, and in the interest of equal standards of medical care throughout the nation, the use of ABT should be further promoted, espe cially in the ''new'' states of the Federal Republic of Germany.