Inter‐hospital variation in use of obstetrical blood transfusion: a population‐based cohort study
| Autor: | Jennifer A. Hutcheon, Lily Lee, Nicholas Au, Amanda Skoll, Nuria Chapinal |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Blood transfusion medicine.medical_treatment Caesarean delivery Population 03 medical and health sciences Population based cohort 0302 clinical medicine Case mix index Risk Factors Humans Medicine Blood Transfusion education Retrospective Studies Pregnancy education.field_of_study 030219 obstetrics & reproductive medicine British Columbia business.industry Obstetrics Postpartum Hemorrhage Obstetrics and Gynecology Delivery Obstetric medicine.disease Regression Analysis Gestation business Procedures and Techniques Utilization Cohort study |
| Zdroj: | BJOG: An International Journal of Obstetrics & Gynaecology. 127:1392-1398 |
| ISSN: | 1471-0528 1470-0328 |
| Popis: | Objective To identify the extent of hospital-to-hospital variation in use of obstetrical blood transfusion. Design Population-based cohort study linking provincial perinatal and blood transfusion registries. Setting British Columbia, Canada, 2004-2015. Population All pregnant women delivering at or beyond 20 weeks' gestation at any British Columbia hospital. Methods Mixed-effects regression models were used to estimate hospital-specific transfusion rates after sequentially accounting for (1) the role of random variation, (2) maternal medical and obstetrical characteristics (i.e. patient case mix) and (3) institutional and delivery factors (such as use of instrumental or caesarean delivery). Main outcome measures Hospital-specific use of obstetrical red blood cell transfusion. Results Among 44 hospitals, crude institutional transfusion rates across the study period ranged from 3.7 to 23.6 per 1000, with an average of 8.3 per 1000. After adjusting for maternal characteristics, institution and delivery risk factors, a nearly three-fold difference in rates between the 10th and 90th percentile remained (5.4-14.5 per 1000). Twelve sites had rates significantly higher or lower than the provincial average. Women residing in remote areas were 2.5-fold (95% CI 1.8-3.5] more likely to receive a blood transfusion than were women residing in metropolitan areas. Conclusions Meaningful variation between hospitals in use of blood transfusion during pregnancy was not explained by differences in patient case-mix or institutional factors, suggesting that over- or under-utilisation of this resource may be occurring in obstetrical care. Tweetable abstract Use of blood transfusion in pregnant women varied broadly between hospitals in British Columbia, Canada. |
| Databáze: | OpenAIRE |
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