Use of interventions to minimise perioperative allogeneic blood transfusion in Australia - A survey by the International Study of Perioperative transfusion (ISPOT) study group

Objective: To investigate use of interventions to minimise need for periope rative transfusion of allogeneic blood in surgical units in Australia. Design: Two questionnaire-based surveys of practice. Setting: All hospitals in Australia, 1996-1997. Participants: Survey 1: all Australian hospitals that have at least 50 beds and undertake surgery; Survey 2: surgical units identified as using the in terventions. Main outcome measures: Reported rates of use of the various interventions ( preoperative autologous donation, acute normovolaemic haemodilution [ANH], cell salvage, and drugs); use of guidelines; and perceptions about the appr opriateness of current levels of use. Results: Survey 1 was returned by 349 of 400 hospitals (87%) and Survey 2 b y 324 of 578 surgical units (56%). Preoperative autologous donation was mos t widely used (70% of hospitals), most commonly in units performing orthopa edic or vascular surgery (65% and 37%, respectively). Cell salvage and ANH were used by 27% and 24% of hospitals, respectively, most often in units pe rforming cardiothoracic (40% and 44%, respectively) and vascular surgery (2 9% and 15%, respectively). These three interventions were used significantl y more in private than in public hospitals (P<0.05). Use of printed guideli nes was uncommon. Respondents considered that autologous transfusion techni ques should be used more widely because of their perceived efficacy and con cerns about safety of allogeneic blood. Perceived barriers to greater use i ncluded lack of surgeon or physician interest, uncertain scheduling of surg ery in public hospitals and cost (cell salvage). Drugs to minimise blood lo ss were used by fewer than 10% of hospitals. Conclusions: Interventions to minimise the need for perioperative allogenei c blood transfusion (apart from drugs) are widely used in Australia. Howeve r, enthusiasm for intraoperative techniques of re-infusing autologous blood needs to be assessed against the evidence of their efficacy and cost-effec tiveness.