For a study, the researchers sought to conduct a meta-analysis of RCTs that compared intraoperative RBC transfusion techniques to find how they affected postoperative morbidity, mortality, and blood product usage. RBC transfusions were common in surgery and were associated with many variabilities, even when case-mix is taken into account. There were few evidence-based recommendations for RBC transfusion in the operating room. An earlier Cochrane Review inspired the search approach. From January 2016 to February 2021, electronic databases were searched. Studies from the previous Cochrane Review were evaluated for inclusion if published before 2016. The researchers looked for RCTs that compared intraoperative transfusion methods. 30-day mortality and morbidity were co-primary outcomes. RBC transfusion was performed intraoperatively and perioperatively as a secondary result. Random-effects models were used in the meta-analysis. A total of 14 studies with 8,641 patients were included in the study. About 56% of participants were enrolled in 1 heart surgery trial. When restrictive and liberal protocols were compared, there was no difference in 30-day mortality [relative risk (RR) 0.96, 95% CI 0.71–1.29] or pooled postoperative morbidity across the examined outcomes. With limiting triggers, 2 trials indicated worse mixed results. The restrictive group received considerably fewer intraoperative (RR 0.53, 95% CI 0.43–0.64) and perioperative (RR 0.70, 95% CI 0.62–0.79) blood transfusions than the liberal group. In 12 of 14 trials, intraoperative restriction transfusion techniques reduced perioperative transfusions without increasing postoperative morbidity or mortality. About 2 experiments had negative results. Given the trial design and generalizability constraints, there was still some concern about the safety of using little transfusion triggers in the operating room. Trials devoted solely to intraoperative transfusions were critically required.
Source:journals.lww.com/annalsofsurgery/Fulltext/2022/03000/A_Systematic_Review_and_Meta_analysis_of.9.aspx
