Nonclinical factors affecting intraoperative red blood cell transfusion: a systematic review

Purpose There is significant variability in intraoperative red blood cell (RBC) transfusion practice. We aimed to use the theoretical domains framework (TDF) to categorize nonclinical and behavioural factors driving intraoperative RBC transfusion practice in a systematic review of the literature. So...

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Bibliographic Details
Published in:Canadian journal of anesthesia 2024-07, Vol.71 (7), p.1023-1036
Main Authors: Lenet, Tori, Berthelot, Pauline, Grudzinski, Alexa L., Banks, Alexander, Tropiano, Joseph, McIsaac, Daniel I., Tinmouth, Alan, Patey, Andrea M., Fergusson, Dean A., Martel, Guillaume
Format: Article
Language:English
Subjects:
Anesthesiology
Cardiology
Critical Care Medicine
Decision making
Intensive
Medicine
Medicine & Public Health
Pain Medicine
Pediatrics
Pneumology/Respiratory System
Review Article/Brief Review
Systematic review
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Summary:Purpose There is significant variability in intraoperative red blood cell (RBC) transfusion practice. We aimed to use the theoretical domains framework (TDF) to categorize nonclinical and behavioural factors driving intraoperative RBC transfusion practice in a systematic review of the literature. Source We searched electronic databases from inception until August 2021 to identify studies evaluating nonclinical factors affecting intraoperative RBC transfusion. Using the Mixed Methods Appraisal Tool, we assessed the quality of included studies and identified relevant nonclinical factors, which were coded into TDF domains by two independent reviewers using NVivo (Lumivero, QSR International, Burlington, MA, USA). We identified common themes within domains and sorted domains based on the frequency of reported factors. Principal findings Our systematic review identified 18 studies: nine retrospective cohort studies, six cross-sectional surveys, and three before-and-after studies. Factors related to the social influences, behavioural regulation, environmental context/resources, and beliefs about consequences domains of the TDF were the most reported factors. Key factors underlying the observed variability in transfusion practice included the social effects of peers, patients, and institutional culture on decision-making (social influences), and characteristics of the practice environment including case volume, geographic location, and case start time (environmental context/resources). Studies reported variable beliefs about the consequences of both intraoperative transfusion and anemia (beliefs about consequences). Provider- and institutional-level audits, educational sessions, and increased communication between surgeons/anesthesiologists were identified as strategies to optimize intraoperative transfusion decision-making (behavioural regulation). Conclusion Our systematic review has synthesized the literature on nonclinical and behavioural factors impacting intraoperative transfusion decision-making, categorized using the TDF. These findings can inform evidence-based interventions to reduce intraoperative RBC transfusion variability. Study registration Open Science Framework ( https://osf.io/pm8zs/?view_only=166299ed28964804b9360c429b1218c1 ; first posted, 3 August 2022)
ISSN:0832-610X
1496-8975
1496-8975
DOI:10.1007/s12630-024-02739-9