Physicians are well aware of the risks of blood transfusion. Does physician knowledge of these risks match the perceptions patients might have concerning the risk of transfusion? Dr. Thomas R. Vetter, Department of Anesthesiology, University of Alabama at Birmingham, Birmingham, Alabama, and colleagues assessed parallel surveys completed by 294 preoperative patients and 73 anesthesiologists and surgeons regarding the potential risks of blood transfusion. The results of their work are published in this month’s issue of Anesthesia & Analgesia in the article titled “Perceptions About Blood Transfusion: A Survey of Surgical Patients and Their Anesthesiologists and Surgeons.”
Physicians regarded transfusion as more risky overall than patients did, although for the 5 individual categories of risk studied (allergic reaction, dyspnea, fever, viral transmission, and medical error), patients were more concerned than physicians. This result is perhaps not surprising given emerging knowledge about the nonspecific association between transfusion and increased risk for organ system failure, prolonged length of stay, and mortality. This observation is more likely to be known to physicians than to patients, whereas specific risks of transfusion – such as transmission of hepatitis or HIV – are known to both groups but recognized as very low risk by the physicians. Of note, 95% of the patients surveyed reported that they would accept a transfusion if it was recommended by a physician.
The survey noted increased concern with transfusion in older, minority, and less-educated patients. The study as a whole suggests that educational gaps exist in the knowledge of preoperative patients and identifies those who are more likely to need careful counseling. As promoters of shared decision making in new models of care such as the Perioperative Surgical Home proposed by the American Society of Anesthesiologists, we anesthesiologists should take note of these findings in order to improve our individual understanding of potential gaps in patients’ knowledge about blood transfusion prior to surgery and what concerns our patients most when consenting them for transfusion in the perioperative period.