Variation in Red Blood Cell Transfusion Practices During Cardiac Operations Among Centers in Maryland: Results From a State Quality-Improvement Collaborative
| Autor: | Christopher C. Kwon, James M. Brown, Glenn J.R. Whitman, Mark G. Nelson, Elena Blasco-Colmenares, J. Trent Magruder, John V. Conte, Rawn Salenger, Keith A. Horvath, Diane Alejo, Jennifer Bobbitt, Clifford E. Fonner, Todd C. Crawford |
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| Rok vydání: | 2017 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Blood Loss Surgical 030204 cardiovascular system & hematology Hematocrit Intraoperative Period 03 medical and health sciences 0302 clinical medicine Aortic valve replacement Internal medicine medicine Humans Postoperative Period 030212 general & internal medicine Myocardial infarction Cardiac Surgical Procedures Aged Retrospective Studies Maryland medicine.diagnostic_test business.industry Retrospective cohort study Middle Aged medicine.disease Quality Improvement Confidence interval Cardiac surgery Quartile Emergency medicine Cardiology Female Surgery Erythrocyte Transfusion Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | The Annals of Thoracic Surgery. 103:152-160 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2016.05.109 |
| Popis: | Background Variation in red blood cell (RBC) transfusion practices exists at cardiac surgery centers across the nation. We tested the hypothesis that significant variation in RBC transfusion practices between centers in our state's cardiac surgery quality collaborative remains even after risk adjustment. Methods Using a multiinstitutional statewide database created by the Maryland Cardiac Surgery Quality Initiative (MCSQI), we included patient-level data from 8,141 patients undergoing isolated coronary artery bypass (CAB) or aortic valve replacement at 1 of 10 centers. Risk-adjusted multivariable logistic regression models were constructed to predict the need for any intraoperative RBC transfusion, as well as for any postoperative RBC transfusion, with anonymized center number included as a factor variable. Results Unadjusted intraoperative RBC transfusion probabilities at the 10 centers ranged from 13% to 60%; postoperative RBC transfusion probabilities ranged from 16% to 41%. After risk adjustment with demographic, comorbidity, and operative data, significant intercenter variability was documented (intraoperative probability range, 4% –59%; postoperative probability range, 13%–39%). When stratifying patients by preoperative hematocrit quartiles, significant variability in intraoperative transfusion probability was seen among all quartiles (lowest quartile: mean hematocrit value, 30.5% ± 4.1%, probability range, 17%–89%; highest quartile: mean hematocrit value, 44.8% ± 2.5%; probability range, 1%–35%). Conclusions Significant variation in intercenter RBC transfusion practices exists for both intraoperative and postoperative transfusions, even after risk adjustment, among our state's centers. Variability in intraoperative RBC transfusion persisted across quartiles of preoperative hematocrit values. |
| Databáze: | OpenAIRE |
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