Hospital variation in quality indicators for patient blood management in total knee and hip arthroplasty: a retrospective cohort study.

Autor:	Garcia-Casanovas A; Perioperative Medicine Research Group, Hospital del Mar Research Institute, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain. Electronic address: albehrt@gmail.com., Bisbe E; Perioperative Medicine Research Group, Hospital del Mar Research Institute, Barcelona, Spain; Department of Anaesthesia, Parc de Salut Mar, Barcelona, Spain., Garcia-Altes A; Departament de Salut, Generalitat de Catalunya, Barcelona, Spain., Vizoso A; Medical Statistics Unit, Hospital del Mar Research Institute, Barcelona, Spain., Duran-Jorda X; Medical Statistics Unit, Hospital del Mar Research Institute, Barcelona, Spain., Sanchez-Pedrosa G; Department of Anaesthesia, Hospital General Universitario Gregorio Marañón, Madrid, Spain., Barquero M; Department of Anaesthesia, Hospital Universitari de Bellvitge, Barcelona, Spain., Colomina MJ; Department of Anaesthesia, Hospital Universitari de Bellvitge, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain., Basora M; Department of Anaesthesia, Hospital Clínic, Barcelona, Spain.
Jazyk:	angličtina
Zdroj:	British journal of anaesthesia [Br J Anaesth] 2024 Sep; Vol. 133 (3), pp. 637-646. Date of Electronic Publication: 2024 Jun 25.
DOI:	10.1016/j.bja.2024.05.019
Abstrakt:	Background: Anaemia, blood loss, and blood transfusion are critical aspects of patient care in major orthopaedic surgery. We assessed hospital adherence to guideline-recommended Patient Blood Management (PBM) care, analysed variations between hospitals, and validated two composite indicators of hospital PBM performance in patients undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA). Methods: This retrospective cohort study included all primary TKA and THA procedures performed during 2021 across 39 hospitals in Spain. We assessed hospital adherence to key guideline-recommended PBM interventions using nine individual quality indicators and two types of composite quality indicators (cQIs): opportunity-based (cQI1) and all-or-none (cQI2). We validated these cQIs by analysing their associations with the adjusted total transfusion index using linear regression. Results: We included 8561 patient episodes from 33 hospitals in the analysis. Delivery of PBM care was similar for TKA and THA. Patients received 62% of the analysed PBM interventions and only 12% of patients underwent the full PBM pathway. Higher hospital cQIs scores were associated with a lower adjusted total transfusion index, both in TKA and THA. The greatest association was found for cQI1 in THA patients (β=-1.18 [95% confidence interval -2.00 to -0.36]; P=0.007). Conclusions: Hospital adherence to guideline-recommended patient blood management care in total hip and knee arthroplasty was suboptimal and varied across centres. Using data that are widely available in hospitals, quality indicators and composite scores could become valuable tools for patient blood management monitoring and comparisons between healthcare organisations. (Copyright © 2024 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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