Percentage of cases with a post transfusion hemoglobin or hematocrit value greater than or equal to 10 g/dL or 30%.

The American Association of Blood Banks (AABB) recommends a transfusion threshold of hemoglobin concentration less than or equal to 8 g/dL or when patient is symptomatic (chest pain, orthostatic hypotension, tachycardia unresponsive to fluid resuscitation, or congestive heart failure).^1,2 Furthermore, blood transfusions in non-cardiac surgery have been associated with increased risk of 30-day mortality and morbidity.^3,4

Although the literature is not conclusive on the exact hemoglobin concentration that requires transfusion, the evidence is clear that use of fewer RBC transfusions reduces cost and risk for adverse effects of transfusion, and that transfusion to  hemoglobin value greater than 10 g/dL or hematocrit greater than 30 is almost always not indicated.⁵ TRAN 02 is an outcome measure examining the number of patients who may have received more blood than necessary.  

90 minutes before the last intraoperative transfusion to 18 hours after Anesthesia End

Any patient that receives a red blood cell transfusion. Transfusion is defined as packed red blood cells or whole blood. See MPOG Concept IDs below for complete list.

• Patients < 18 years of age
• ASA 5 & 6
• Cardiac Procedures
• Massive Blood Loss: EBL ≥ 2000ml
• Massive Transfusion: Transfusion of 4 or more units of blood; 4 hours before Anesthesia Start to Anesthesia End
  • Note for sites that document transfusions in ml instead of units: ASPIRE will default to 300ml/unit.
• Labor Epidurals as determined by the MPOG 'Obsteric Anesthesia Type' phenotype results 'Labor Epidural' and 'Conversion (Labor Epidural Portion)'
• Obstetric Non-Operative Procedures – CPT 01958
• Exclude patients with an EBL > 1500cc during cesarean section as determined by MPOG ‘Obstetric Anesthesia Type’ phenotype results:
  • ‘Cesarean Delivery’
  • ‘Cesarean Hysterectomy’
  • ‘Conversion (Cesarean Delivery portion)’
  • ‘Conversion (Cesarean Hysterectomy portion)’
  • 'Conversion (Labor Epidural and Cesarean Delivery Combined)'
• Exclude patients with a HR>110, SBP<85, DBP<45, or O2Sat <95% during cesarean section as determined by MPOG ‘Obstetric Anesthesia Type’ phenotype results:
  • ‘Cesarean Delivery’
  • ‘Cesarean Hysterectomy’
  • ‘Conversion (Cesarean Delivery portion)’
  • ‘Conversion (Cesarean Hysterectomy portion)’
  • 'Conversion (Labor Epidural and Cesarean Delivery Combined)'
• Exclude postpartum hemorrhage cases (ICD-10 code: O72.0, O72.1, O72.2, O72.3)
• Cases where the ‘Measure End Time’ precedes ‘Measure Start Time’ will be excluded and marked 'invalid'

• Hematocrit value documented as less than or equal to 30% and/or hemoglobin value documented as less than or equal 10 g/dL     OR
• No hematocrit or hemoglobin checked within 18 hours of anesthesia end.

• Considerations:
  • All hemoglobin/hematocrit lab values drawn after the last transfusion and within 18 hours after anesthesia end will be evaluated. If the lowest of these values is ≤10g/dL or ≤30%, the case will pass.
  • If the hemoglobin or hematocrit at the time of the last transfusion (within 90 minutes before) is less than or equal to 8/24, the case will pass.

Not applicable

Individual who administered the transfusion

1. Carson JL, Grossman BJ, Kleinman S, et al. Red blood cell transfusion: a clinical practice guideline from the AABB*. Annals of internal medicine. 2012;157(1):49-58.
2. Carson JL, Guyatt G, Heddle NM, et al. Clinical Practice Guidelines From the AABB: Red Blood Cell Transfusion Thresholds and Storage. Jama. 2016;316(19):2025-2035.
3. Glance LG, Dick AW, Mukamel DB, et al. Association between intraoperative blood transfusion and mortality and morbidity in patients undergoing noncardiac surgery. Anesthesiology. 2011;114(2):283-292.
4. Napolitano LM, Kurek S, Luchette FA, et al. Clinical practice guideline: red blood cell transfusion in adult trauma and critical care. The Journal of trauma. 2009;67(6):1439-1442.
5. Practice guidelines for perioperative blood management: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management*. Anesthesiology. 2015;122(2):241-275.