Variation in Red Blood Cell Transfusion Practices During Cardiac Operations Among Centers in Maryland: Results From a State Quality-Improvement Collaborative

J. Trent Magruder, Elena Blasco-Colmenares, Todd Crawford, Diane Alejo, John V. Conte, Rawn Salenger, Clifford E. Fonner, Christopher C. Kwon, Jennifer Bobbitt, James M. Brown, Mark G. Nelson, Keith A. Horvath, Glenn R. Whitman

Research output: Contribution to journalArticle

15 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)152-160
Number of pages9
JournalAnnals of Thoracic Surgery
Volume103
Issue number1
DOIs
StatePublished - Jan 1 2017

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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    Magruder, J. T., Blasco-Colmenares, E., Crawford, T., Alejo, D., Conte, J. V., Salenger, R., Fonner, C. E., Kwon, C. C., Bobbitt, J., Brown, J. M., Nelson, M. G., Horvath, K. A., & Whitman, G. R. (2017). Variation in Red Blood Cell Transfusion Practices During Cardiac Operations Among Centers in Maryland: Results From a State Quality-Improvement Collaborative. Annals of Thoracic Surgery, 103(1), 152-160. https://doi.org/10.1016/j.athoracsur.2016.05.109