Autologous blood transfusion in the Federal Republic of Germany - Results of a 1993 questionnaire .2. The use of autologous blood transfusion in the ''old'' and ''new'' states of the Federal Republic of Germany after reunification

In 1993, we conducted a postal survey to assess the use of autologous blood transfusion (ABT) in the Federal Republic of Germany after reunification. The results of this survey have already been reported in a previous paper, but without differentiation between the ''old'' and ''new'' states (former West Germany and former German Democratic Republic, respectively). In the present study, the data of our 1993 survey were further analysed to see if there were differences in the use of ABT between the ''old'' and ''new'' states. Methods. The study is based on data of a 1993 postal survey of German hospitals. Details concerning the performance of the survey have been reported in a previous paper. Briefly, questionnaires were mailed to the anaesthesia departments of 400 randomly selected hospitals in the ''old'' states and 284 hospitals in the ''new'' states of the Federal Republic of Germany. The questionnaires contained 36 questions related to general information on the hospital and the use of ABT; 305 completed questionnaires were returned from the ''old'' states and 197 from the ''new'' states, response rates of 76% and 69%, respectively. For the present investigation, the: responses of the hospitals of the ''old'' and ''new'' states were analysed separately. Frequency distributions of categorical variables were analysed by the chi-square test. Because of multiple testing, statistical significance was attained only at the 0.05% level (P less than or equal to 0.0005). Results. There were no significant differences between the ''old'' and ''new'' states with respect to hospital size by number of beds, percentage of general and specialised hospitals, and percentage of operations requiring blood transfusion. In both the ''old'' and ''new'' states, 9% of the responding hospitals maintained a hospital-based transfusion service, while the other depended on regional blood banks. Preoperative autologous blood donation (PABD) was performed at least ''rarely'' in 85% and 71% (P = 0.0001), and ''mostly'' in 20% and 10% (P = 0.0014) of the hospitals in the ''old'' and ''new'' states, respectively. Uniformly, the principal uses of PABD were for orthopaedic and cardiac surgery. In 62% and 27% (P < 0.0001) of those hospitals that reported performing PABD, the autologous blood service was run by the anaesthesia department. Preoperative plasmapheresis was performed in 14% and 8% (P = 0.008), and isovolaemic haemodilution in 82% and 56% (P < 0.0001) of the hospitals in the ''old'' and ''new'' states, respectively. Automated autotransfusion devices (cell savers) were available in 38% and 19% (P < 0.0001) of the hospitals, respectively. Simple collection devices for perioperative blood salvage were used in 17% and 15% (P = 0.24) of the hospitals in the ''old'' and ''new'' states, respectively. Conclusion. We conclude that ABT is more widely used in the ''old'' than the ''new'' states of the Federal Republic of Germany. ABT is regarded as a desirable alternative to homologous blood transfusion, and in the interest of equal standards of medical care throughout the nation, the use of ABT should be further promoted, especially in the ''new'' states of the Federal Republic of Germany.