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J Thorac Cardiovasc Surg. 2014 Dec;148(6):3084-9. doi: 10.1016/j.jtcvs.2014.07.106. Epub 2014 Aug 14.

Geographic variability in potentially discretionary red blood cell transfusions after coronary artery bypass graft surgery.

Author information

1
Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich. Electronic address: likosky@umich.edu.
2
University of Michigan Medical School, Ann Arbor, Mich.
3
Departments of Medicine and The Dartmouth Institute for Health Care Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH.
4
Starr-Wood Cardiac Group, Portland, Ore.
5
Swedish Heart and Vascular Institute, Seattle, Wash.
6
Division of Cardiac Surgery, Department of Surgery, Henry Ford Hospital, Detroit, Mich.
7
Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich.
8
Department of Surgery, Portsmouth Regional Hospital, Portsmouth, NH.
9
Medical Data Research Center, Providence Health and Services, Portland, Ore.
10
Clinical Outcomes Assessment Program, Seattle, Wash.
11
Department of Cardiovascular Surgery, Beaumont Hospital, Troy, Mich.
12
Department of Biostatistics, University of Michigan, Ann Arbor, Mich.

Abstract

OBJECTIVE:

A number of established regional quality improvement collaboratives have partnered to assess and improve care across their regions under the umbrella of the Cardiac Surgery Quality Improvement (IMPROVE) Network. The first effort of the IMPROVE Network has been to assess regional differences in potentially discretionary transfusions (<3 units red blood cells [RBCs]).

METHODS:

We examined 11,200 patients undergoing isolated nonemergent coronary artery bypass graft surgery across 56 medical centers in 4 IMPROVE Network regions between January 2008 and June 2012. Each center submitted the most recent 200 patients who received 0, 1, or 2 units of RBC transfusion during the index admission. Patient and disease characteristics, intraoperative practices, and percentage of patients receiving RBC transfusions were collected. Region-specific transfusion rates were calculated after adjusting for pre- and intraoperative factors among region-specific centers.

RESULTS:

There were small but significant differences in patient case mix across regions. RBC transfusions of 1 or 2 units occurred among 25.2% of coronary artery bypass graft procedures (2826 out of 11,200). Significant variation in the number of RBC units used existed across regions (no units, 74.8% [min-max, 70.0%-84.1%], 1 unit, 9.7% [min-max, 5.1%-11.8%], 2 units, 15.5% [min-max, 9.1%-18.2%]; P < .001). Variation in overall transfusion rates remained after adjustment (9.1%-31.7%; P < .001).

CONCLUSIONS:

Delivery of small volumes of RBC transfusions was common, yet varied across geographic regions. These data suggest that differences in regional practice environments, including transfusion triggers and anemia management, may contribute to variability in RBC transfusion rates.

Comment in

PMID:
25227699
PMCID:
PMC5082980
DOI:
10.1016/j.jtcvs.2014.07.106
[Indexed for MEDLINE]
Free PMC Article

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