J Trent Magruder1, Elena Blasco-Colmenares2, Todd Crawford1, Diane Alejo1, John V Conte1, Rawn Salenger3, Clifford E Fonner4, Christopher C Kwon5, Jennifer Bobbitt6, James M Brown3, Mark G Nelson7, Keith A Horvath8, Glenn R Whitman9. 1. Division of Cardiac Surgery, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland. 2. Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland. 3. Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland. 4. Maryland Cardiac Surgery Quality Initiative, Baltimore, Maryland. 5. Beverly & Jerome Fine Cardiac Valve Center, Sinai Hospital of Baltimore, Baltimore, Maryland. 6. Department of Cardiac Surgery, Washington Adventist Hospital, Takoma Park, Maryland. 7. The Heart Institute, Western Maryland Health System, Cumberland, Maryland. 8. Cardiothoracic Surgery Research Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland. 9. Division of Cardiac Surgery, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: gwhitman@jhmi.edu.
Abstract
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.
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.
Authors: I Cortés-Puch; B M Wiley; J Sun; H G Klein; J Welsh; R L Danner; P Q Eichacker; C Natanson Journal: Transfus Med Date: 2018-04-19 Impact factor: 2.019
Authors: Dou Huang; Changwei Chen; Yue Ming; Jing Liu; Li Zhou; Fengjiang Zhang; Min Yan; Lei Du Journal: Medicine (Baltimore) Date: 2019-02 Impact factor: 1.817