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Invited Commentary
July 2015

Use of Restrictive Transfusion in Abdominal Surgery: Should Evidence-Based Medicine Replace Art of Medicine?

Author Affiliations
  • 1Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, UPMC Heart and Vascular Institute, Pittsburgh, Pennsylvania
JAMA Surg. 2015;150(7):631. doi:10.1001/jamasurg.2015.111

Ejaz et al1 elegantly demonstrated in a single-institution study that significant monetary savings may be realized if surgeons were to adhere to a restrictive transfusion policy based on concrete intraoperative and postoperative hemoglobin values. There is little doubt that blood transfusion exposes patients to potential risks of bloodborne pathogens.2 Studies have also demonstrated worse short-term outcomes attributable to blood transfusion itself in critically ill patients.3 Recently, a multicenter, prospective, randomized clinical trial demonstrated no long-term mortality difference between liberal and restrictive transfusion strategies.4 In light of the current controversy and changing climate of health care reform, Ejaz and colleagues are to be commended for spearheading this timely and provocative study.