A large variation in transfusion policy between countries and even between hospitals within a country can still be seen as common practice:
- In the first Austrian benchmark study, Gombotz and colleagues found a transfusion rate varying from 16 to 85% for patients undergoing primary total hip replacement (THR) and a 12-87% transfusion rate for patients undergoing primary total knee replacement (TKR) surgery (Gombotz et al. Transfusion 2007).
- In the second benchmark study, which was published recently, transfusion rates have decreased in THR (from 41 to 30%) and TKR (41 to 25%) however with still substantial inter-centre variability (Gombotz et al. Transfusion 2014) These studies show, that the implementation of guidelines in daily practice is often difficult. This is not only relevant for implementing transfusion thresholds, but also for the number of transfusions at each event to reach a particular target Haemoglobin (Hb) level.
Barr and co-workers investigated red blood cell transfusion practice in Northern Ireland in 2005 and still found a two-unit instead of single-unit transfusion practice in medical and surgery patients (n=1474) (Barr et al. Vox Sang 2010).