Sunday, October 17, 2010

Research Highlights: Varied Rate of Transfusion During Bypass Surgery Found in US Hospitals

Varied Rate of Transfusion During Bypass Surgery Found in US Hospitals
By: Caroline Melhado

A study published in the Journal of the American Medical Association, found a wide variability in the frequency of blood transfusions during Coronary Artery Bypass Graft Surgery (CABG) Surgery in hospitals. Researchers used previously collected data from the Society of Thoracic Surgeons Adult Cardiac Surgery Database to analyze the number of patients who received plasma, platelet or allogeneic red blood cells through transfusion. The study found wide discrepancies among hospitals in the US, that remain largely unexplained.
Hospitals that had one CABG surgery per month were included in the trial. Of these 798 sites 102,470 patient reports were examined over 2008. A smaller database, only including hospitals that performed more than 100 surgeries a year found that transfusion rates for plasma differed between hospitals by 0 to 97%, red blood cells 7.8 to 92.8% and 0.4 to 90.4% for platelets.
After controlling for case variability researchers found a significant differences in rates that varied by hospital characteristic. Teaching hospitals and hospitals with a fewer cases of CABG surgery were more likely to have higher rates of transfusion. Rates also differed by geographic region. However multiple modeled analysis concluded that these three factors only factor for 11.1 % difference between rates, while case mix accounted for 20.1%
While the STS has put out numerous regulations on methods of transfusion this study demonstrates that a large range of variability in following these protocols still exists. Further research might shine light on the still unexplained variability that exists between these hospitals.

JAMA. 2010;304(14):1568-1575. doi:10.1001/jama.2010.1406
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