Objective  To investigate blood management in perioperative period for patients using more than or equal to 20 units of blood.

  Methods  Surgical patients using ≥ 20 units of blood in 2015 in Peking Union Medical College Hospital were included. Records regarding their perioperative period were collected, analyzed, and compared between the patients not receiving unplanned secondary surgery and those who received unplanned secondary surgery.

  Results  Thirty-six patients were enrolled. The blood loss during the first surgery was significantly lower in the patients who did have unplanned secondary surgery (n=12) compared with those who did not(n=24) (1300 ml vs. 3000 ml, P < 0.05). Patients had higher American Society of Anesthesiology (ASA) grade in the unplanned secondary surgery compared with the primary surgery, with the number of cases classified as grade Ⅰ-Ⅴ being 0, 0, 4, 8, 0 and 2, 9, 1, 0, 0, respectively. Additionally, the average intraoperative blood loss (2250 ml vs. 1050 ml) and volume of blood transfusion (red blood cell, 8 U vs. 1 U; plasma, 400 ml vs. 100 ml) were higher in the unplanned secondary surgery than in the primary surgery (all P < 0.05). Eighteen patients were complicated with anemia before surgery.

  Conclusions  For patients at high risk and receiving complex surgery, individualized treatment plan, therapy for anemia before selective surgery, careful hemostasis during operation, and perioperative monitoring of coagulation function may reduce the need for unplanned secondary surgery and improve patient outcome.