Perioperative Transfusion Trigger Score Versus Restrictive Transfusion in Older Non-Cardiac Surgery Patients: A Multicenter Randomized Controlled Trial.

BACKGROUND

Restrictive transfusion (Hb < 7 g/dL) is recommended for most perioperative patients, but the optimal threshold for those with cardiovascular disease or Hb 7-10 g/dL remains uncertain. The Perioperative Transfusion Trigger Score (POTTS), which integrates adrenaline requirement, FiO2, temperature, and angina history, may standardize decisions and safely reduce transfusions in older non-cardiac surgery patients.

METHODS

This multicenter RCT in two Chinese hospitals randomized patients ≥ 60 years undergoing non-cardiac surgery 1:1 to POTTS or control. POTTS = 6 plus points for adrenaline, FiO2 (to maintain SpO2 ≥ 95%), core temperature, and angina; transfusion when Hb < POTTS. Control followed 2012 AABB guideline (Hb < 7 always transfuse; > 10 not; 7-10 physician discretion).

PRIMARY OUTCOME: proportion receiving allogeneic RBC transfusion during perioperative period (ITT population).

RESULTS

253 patients (mean age 72.3 years; 67.6% women) were randomized (May 2023-Sept 2025). Baseline Hb similar (median 9.60 vs. 9.50 g/dL). In ITT, transfusion required in 24.00% (30/125) of POTTS vs. 35.94% (46/128) of control (p = 0.038). Transfusion volume did not differ significantly (median 2.50 vs. 3.00 units, p = 0.520). Overall complication rates: 12.80% vs. 8.59% (p = 0.279); one death in control group (0.85%). No significant differences in specific complications.

CONCLUSION

In patients ≥ 60 years undergoing non-cardiac surgery, POTTS-guided transfusion significantly reduced the proportion of patients transfused without increasing complications.

TRIAL REGISTRATION: This study was registered at http://www.chictr.org.cn (#ChiCTR2300071739).