Too many blood transfusions, doctors say

(AFP) – There are still too many blood transfusions during operations in France, say health professionals, who made recommendations on Thursday to limit this expensive medical gesture and sometimes risky in cases where it is really unavoidable.

"The transfusion has decreased a lot over the last 20 years," said Xavier Capdevila, president of the French Society for Anesthesia and Reanimation (SFAR), who spoke at a conference at the French Academy. of medicines.

Approximately 45% of patients transfused into operations planned with a significant risk of bleeding have moved to "transfusion rates that are more or less 10-13%, which is still high," he added. .

In more than half of the cases (59%), the decision to transfacate is "probably not appropriate" and in about one-third (29%) the relevance for the patient is "uncertain", according to an analysis conducted in 2011 . by international experts from the subject.

However, transfusion involves risks of significant complications for the patient. According to various studies, patients who have been transfused during surgery have a higher risk of death, infection, stroke or venous thrombosis, speakers of conferences reminded.

Moreover, the use of these blood products is expensive for hospitals – about 250 euros per bag of blood, not to mention the costs associated with the extension of the stay in the hospital.

According to Pascal Paubet, researcher in health economics and head of public health at the Henri-Mondor hospital in Créteil, health insurance could save nearly € 200 million a year for orthopedic surgery by only applying a strategy designated at international level under the term "blood management of patients".

This strategy includes treatment of anemic patients with iron injections or erythropoietin (EPO) prior to surgery. When the hemoglobin level in the blood is too low, the chance of transfusion in the event of bleeding is indeed much greater.

Health professionals also make various recommendations to limit bleeding during surgery (use of antihemorrhagic products, minimally invasive surgery that limits incisions, etc.).

Finally, the follow-up of the patient after surgery should "help him optimize his hemoglobin or help him support his anemia in the case of a hemoglobin concentration that is low," Prof Capdevila added.

These recommendations are included in a whitepaper, developed by seven scientific associations, including anesthetists and orthopedic and thoracic surgeons.

If there are initiatives in this direction in France, especially in the University Hospital of Angers, the authors of the whitepaper hope that official experiments will be set up before a possible program is organized at national level.

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