This is an interesting multicenter, retrospective, cohort study of RBC transfusion in major orthopedic surgery (n = 701 arthroplasties) performed in three different hospitals in Canada. The authors couldnt find any difference in the way physicians use RBC transfusions between hospitals, when studying each variable potentially involved in the decision to transfuse. Their data suggest that physicians mainly base their decision to transfuse on the Hb concentration but little or not on the patients characteristics, despite published nuances in transfusion guidelines. Even though a restrictive approach was used (pretransfusion Hb between 7.5-8.0 g/dL), the transfusion rate was near 30%.

– Elvira Bisbe