Abstract
Blood transfusions occur in ∼2% of U.S. cesarean deliveries. Despite established guidelines, obstetric patients are often over-transfused, leading to unnecessary risk and inefficient use of limited blood products. Allowable blood loss (ABL) offers an individualized transfusion threshold that may reduce avoidable intraoperative transfusions and associated costs. This study explores the clinical and economic impact of ABL reporting during cesarean timeouts at a quaternary care safety-net hospital.
A retrospective cohort study compared transfusion practices before (Sept 2022–Jan 2023) and after (Aug 2024–Dec 2024) ABL reporting was introduced. Patients with preoperative hemoglobin (Hgb) <7 g/dL or only autologous cell-salvaged blood were excluded. Descriptive and nonparametric tests were employed, with significance set at p < .05. Holm-Bonferroni corrections were applied for correlated variables.
87 patients met inclusion criteria (pre n=76; post n=11). Post-intervention patients had lower preoperative Hb (p= .027) and ABL (p = .020), but similar blood loss, PPH risk, and postoperative outcomes. Data showed reductions in avoidable intraoperative transfusions and unused units of pRBCs per patient with no statistically reliable trend. (p = 1.000; p = 1.000).
The modest trend towards improved stewardship following ABL reporting during cesarean timeouts may yield economic benefits through reduced crossmatching, fewer unused units, and monthly reductions in total and avoidable transfusions. This simple intervention may enhance transfusion stewardship, reduce inefficient use of scarce resources, and decrease costs. Larger studies are needed to confirm these preliminary findings and assess long-term outcomes.