Criteria used to define appropriate red blood cell transfusion in the perioperative setting: a scoping review

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INTRODUCTION: Intraoperative red blood cell (RBC) transfusion strategies vary depending on multiple factors. Several studies have documented significant variability in RBC transfusion practices during surgery. This scoping review aimed to identify and describe existing criteria or clinical decision-making tools used to evaluate intraoperative and immediate post-operative RBC transfusion appropriateness. METHODS: A scoping review was conducted and reported according to Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with extension for scoping reviews. A systematic search of MEDLINE and EMBASE was conducted. Relevant references were also explored. Studies reporting on the development, use, or validation of a clinical tool or set of criteria to adjudicate the appropriateness of intra- or post-operative RBC transfusions were eligible for inclusion. RESULTS: A total of 3,342 de-duplicated articles were identified. 135 underwent full text review, and 28 were included in the analysis. One tool was designed specifically for use during surgery. Adjudication of perioperative RBC transfusion appropriateness was determined using pre-existing published society guidelines in 61% of studies. 29% used a pre-defined set of criteria selected by the study team, and one study used RAND-UCLA to achieve consensus on appropriate transfusion criteria. CONCLUSION: This review identified several tools that were used to adjudicate the appropriateness of intraoperative and immediate postoperative RBC transfusions. Almost all studies adjudicated transfusion appropriateness based on guidelines intended for use outside of perioperative settings. Further research is required to develop RBC transfusion adjudication criteria that specifically integrate the unique factors that influence transfusion in the perioperative setting.

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