Red Blood Cell Transfusion Practices in Patients Undergoing Orthopedic Surgery: A Multi-Institutional Analysis
Autor: | A M Audet, C Andrzejewski, M A Popovsky |
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Rok vydání: | 1998 |
Předmět: |
Male
medicine.medical_specialty Arthroplasty Replacement Hip Red Blood Cell Transfusion Hematocrit Medicare Blood cell Blood Transfusion Autologous medicine Humans Orthopedics and Sports Medicine In patient Practice Patterns Physicians' Elective surgery Arthroplasty Replacement Knee Aged Retrospective Studies medicine.diagnostic_test business.industry Medical record Hospitals United States Surgery Red blood cell medicine.anatomical_structure Massachusetts Practice Guidelines as Topic Utilization Review Orthopedic surgery Blood Banks Female Guideline Adherence Erythrocyte Transfusion business Total Quality Management |
Zdroj: | Orthopedics. 21:851-858 |
ISSN: | 1938-2367 0147-7447 |
Popis: | This retrospective review analyzed and compared transfusion practices in patients undergoing orthopedic surgery in five Massachusetts hospitals with current practice guidelines; opportunities for improvement were identified. Patient-specific clinical information and data about transfusion practices were obtained from the medical records of 384 Medicare patients undergoing orthopedic surgery between January 1992 and December 1993. The number of patients who donated autologous blood preoperatively differed significantly among hospitals as did the number of autologous units that were unused. The number of blood units transfused at each transfusion event also differed significantly; some surgeons transfused ≥2 units in the majority of their patients, while others transfused 1 unit at a time. This variation in practice was not explained by differences in patients' clinical status. The mean pretransfusion hematocrit was higher for autologous versus allogeneic blood, suggesting more liberal criteria to transfuse autologous blood. Nearly half of all transfusion events were determined to have been potentially avoidable. Avoidable transfusions were also three to seven times more likely with autologous than with allogeneic blood. Significant inter-hospital differences existed in the number of elective surgery patients exposed to allogeneic blood. The major determinant of allogeneic blood use in these patients was the availability of autologous blood. Each additional autologous blood unit available decreased the odds of allogeneic blood exposure twofold. Differences in intraoperative and postoperative blood salvage use also were noted. These findings indicate that significant variations in practice exist. Comparative data enabled hospitals to identify and target specific areas for improvement. |
Databáze: | OpenAIRE |
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