期刊
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
卷 163, 期 3, 页码 1015-+出版社
MOSBY-ELSEVIER
DOI: 10.1016/j.jtcvs.2020.04.141
关键词
coronary artery bypass; cardiac surgical procedures; erythrocyte transfusions; perioperative care; blood loss/surgical; bypass/cardiopulmonary
资金
- Agency for Healthcare Research and Quality [AHRQ] [R01HS026003]
- National Institutes of Health [NIH] [R01HL146619]
- Blue Cross and Blue Shield of Michigan (BCBSM)
- Blue Care Network as part of the BCBSM Value Partnerships program
In coronary artery bypass grafting surgery, 41.5% of patients receiving red blood cell transfusions were female, older, and had a smaller body surface area. The study results suggest that center-level transfusion variation cannot be fully explained by patient and procedural factors.
Objective: To identify to what extent distinguishing patient and procedural characteristics can explain center-level transfusion variation during coronary artery bypass grafting surgery. Methods: Observational cohort study using the Perfusion Measures and Outcomes Registry from 43 adult cardiac surgical programs from July 1, 2011, to July 1, 2017. Iterative multilevel logistic regression models were constructed using patient demographic characteristics, preoperative risk factors, and intraoperative conservation strategies to progressively explain center-level transfusion variation. Results: Of the 22,272 adult patients undergoing isolated coronary artery bypass surgery using cardiopulmonary bypass, 7241 (32.5%) received at least 1 U allogeneic red blood cells (range, 10.9%-59.9%). When compared with patients who were not transfused, patients who received at least 1 U red blood cells were older (68 vs 64 years; P<.001), were women (41.5% vs 15.9%; P<.001), and had a lower body surface area (1.93 m2 vs 2.07 m2; P<.001), respectively. Among the models explaining center-level transfusion variability, the intraclass correlation coefficients were 0.07 for model 1 (random intercepts), 0.12 for model 2 (patient factors), 0.14 for model 3 (intraoperative factors), and 0.11 for model 4 (combined). The coefficient of variation for center-level transfusion rates were 0.31, 0.29, 0.40, and 0.30 for models 1 through 4, respectively. The majority of center-level variation could not be explained through models containing both patient and intraoperative factors. Conclusions: The results suggest that variation in center-level red blood cells transfusion cannot be explained by patient and procedural factors alone. Investigating organizational culture and programmatic infrastructure may be necessary to better understand variation in transfusion practices.
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