Donald S Likosky1, Min Zhang2, Gaetano Paone3, John Collins4, Alphonse DeLucia5, Theodore Schreiber6, Patty Theurer7, Samer Kazziha8, Dale Leffler9, Douglas J Wunderly10, Hitinder S Gurm11, Richard L Prager7. 1. Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI. Electronic address: likosky@umich.edu. 2. Department of Biostatistics, University of Michigan, Ann Arbor, MI. 3. Department of Surgery, Division of Cardiac Surgery, Henry Ford Hospital, Detroit, MI. 4. St Mary's of Michigan Saginaw, Saginaw, MI. 5. Department of Cardiothoracic Surgery, Bronson Methodist Hospital, Bronson, MI. 6. Detroit Medical Center-Cardiovascular Institute, Detroit, MI. 7. Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI. 8. Crittenton Hospital, Rochester, MI. 9. Thoracic & Cardiovascular Institute, Sparrow Hospital, Lansing, MI. 10. Department of Cardiology, Bronson Methodist Hospital, Bronson, MI. 11. Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI.
Abstract
BACKGROUND: Red blood cell (RBC) transfusions have been associated with morbidity and mortality in both coronary artery bypass grafting (CABG) and percutaneous coronary interventions (PCI). As a mechanism for identifying determinants of RBC practice, we quantified the relationship between a center's PCI and CABG transfusion rate. METHODS: We identified all patients undergoing CABG (n = 16,568) or PCI (n = 94,634) at each of 33 centers from 2010 through 2012 in the state of Michigan and compared perioperative RBC transfusion rates for CABG and PCI at each center. Crude and adjusted transfusion rates were modeled separately. We adjusted for common preprocedural risk factors (12 for CABG and 23 for PCI) and reported Pearson correlation coefficients based on the crude and risk-adjusted rates. RESULTS: As expected, RBC transfusion was more common after CABG (mean 46.5%) than PCI (mean 3.3%), with wide variation across centers for both (CABG min:max 26.5:71.3, PCI min:max 1.6:6.0). However, RBC transfusion rates were significantly correlated between CABG and PCI in both crude, 0.48 (P = .005), and adjusted, 0.53 (P = .001), analyses. These findings were consistent when restricting to nonemergent cases (radj = 0.44, P = .001). CONCLUSIONS: Red blood cell transfusion rates were significantly correlated between the CABG and PCI at individual hospitals in Michigan, independent of patient case mix. Future work should explore institutional practice patterns, philosophies, and guidelines for RBC transfusions.
BACKGROUND: Red blood cell (RBC) transfusions have been associated with morbidity and mortality in both coronary artery bypass grafting (CABG) and percutaneous coronary interventions (PCI). As a mechanism for identifying determinants of RBC practice, we quantified the relationship between a center's PCI and CABG transfusion rate. METHODS: We identified all patients undergoing CABG (n = 16,568) or PCI (n = 94,634) at each of 33 centers from 2010 through 2012 in the state of Michigan and compared perioperative RBC transfusion rates for CABG and PCI at each center. Crude and adjusted transfusion rates were modeled separately. We adjusted for common preprocedural risk factors (12 for CABG and 23 for PCI) and reported Pearson correlation coefficients based on the crude and risk-adjusted rates. RESULTS: As expected, RBC transfusion was more common after CABG (mean 46.5%) than PCI (mean 3.3%), with wide variation across centers for both (CABG min:max 26.5:71.3, PCI min:max 1.6:6.0). However, RBC transfusion rates were significantly correlated between CABG and PCI in both crude, 0.48 (P = .005), and adjusted, 0.53 (P = .001), analyses. These findings were consistent when restricting to nonemergent cases (radj = 0.44, P = .001). CONCLUSIONS: Red blood cell transfusion rates were significantly correlated between the CABG and PCI at individual hospitals in Michigan, independent of patient case mix. Future work should explore institutional practice patterns, philosophies, and guidelines for RBC transfusions.
Authors: Jared P Beller; William Z Chancellor; J Hunter Mehaffey; Robert B Hawkins; Matthew R Byler; Alan M Speir; Mohammed A Quader; Andy C Kiser; Leora T Yarboro; Gorav Ailawadi; Nicholas R Teman Journal: Ann Thorac Surg Date: 2020-02-11 Impact factor: 4.330
Authors: David C Fitzgerald; Annie N Simpson; Robert A Baker; Xiaoting Wu; Min Zhang; Michael P Thompson; Gaetano Paone; Alphonse Delucia; Donald S Likosky Journal: J Thorac Cardiovasc Surg Date: 2020-05-13 Impact factor: 5.209
Authors: Eirini Apostolidou; Dhaval Kolte; Kevin F Kennedy; Charles E Beale; J Dawn Abbott; Afshin Ehsan; Hitinder S Gurm; Jeffrey L Carson; Shafiq Mamdani; Herbert D Aronow Journal: J Am Heart Assoc Date: 2020-11-03 Impact factor: 5.501