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Retrospective cohort study
Intraoperative transfusion in older patients with low preoperative haematocrit levels and substantial blood loss during major non-cardiac surgery is associated with lower 30-day postoperative mortality
  1. Jeffrey L Carson1,
  2. Sarang Kim1
  1. 1UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersy, USA
  1. Correspondence to Jeffrey L Carson
    Division of General Internal Medicine, UMDNJ-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ 08903, USA; carson{at}

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More than 81 million red blood cell units are collected annually throughout the world.1 Yet the indications for transfusion in most settings are unknown. Clinical trials in surgical patients have generally compared transfusion strategies at two haemoglobin concentrations and have not evaluated intraoperative transfusions. Thus, this analysis is unique.


A retrospective cohort study was performed in about 240 000 patients of 65 years of age and older who underwent non-cardiac surgery. Intraoperative blood loss was estimated from the preoperative haematocrit, lowest postoperative haematocrit and amount of blood transfused intraoperatively. A priori, preoperative haematocrit was categorised into four levels: <24%, 24–29.9%, 30–35.9% and ≥36%, and estimated blood loss was stratified into <500, 500–999 and ≥1000 cc. A propensity score was developed to predict each patient's probability of receiving an intraoperative transfusion. Patients …

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  • Competing interests JLC has received research support for clinical trials evaluating transfusion thresholds (1RC2HL101458 and 1U01 HL73958) from the National Heart, Lung, and Blood Institute, National Institutes of Health.