Quality metrics for perioperative red blood cell transfusion in gastrointestinal cancer surgery: international Delphi consensus

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BACKGROUND: Perioperative red blood cell transfusion (RBCT) in gastrointestinal (GI) cancer surgery is associated with increased postoperative morbidity and higher healthcare costs. There are no standardized quality metrics to evaluate perioperative RBCT use. The aim of this study was to develop consensus-based quality metrics to assess and monitor perioperative RBCT in GI cancer surgery. METHODS: A four-round Delphi process was conducted with 37 multidisciplinary international experts. After rating the importance of an initial list of possible metrics, panellists ranked them for priority and scored them for feasibility. Metrics were retained if rated as important and feasible. Consensus was defined as a median score between 4 and 5 and ≤ 22 panellists rating outside the score category containing the median. RESULTS: Of 72 candidate metrics, 18 were retained after prioritization and feasibility scoring: five process, five outcome, and eight structure metrics. Process metrics included rate of perioperative RBCT at 3 days stratified by intraoperative and postoperative timing, and rate of RBCTs administered with haemoglobin > 7 g/dl, in patients undergoing GI cancer surgery. Outcome metrics included 30-day major morbidity and mortality, transfusion reactions, and patient-reported outcomes in patients receiving perioperative RBCT. Structure metrics addressed access to an on-site blood bank and the availability of institutional protocols for massive transfusion, anticoagulation reversal, and indications for perioperative RBCT. CONCLUSION: Through an international Delphi consensus, quality metrics were identified to support the monitoring of perioperative RBCT for GI cancer surgery. These metrics are important for quality monitoring, including institutional audits and performance assessment, to reduce variation in the use of RBCT, improve outcomes, and optimize blood product utilization.

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