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The proportion of variation in perioperative transfusion decisions in Canada attributable to the hospital

La proportion de variation dans les pratiques transfusionnelles périopératoires au Canada imputable aux hôpitaux

Abstract

Purpose

Hospital variation in transfusion practices has been described previously but the proportion of variation attributable to the hospital has not. The objective of this report was to quantify hospital variation in red cell transfusion decisions perioperatively for patients undergoing coronary artery bypass surgery (CABG).

MethodsWe used a cross-sectional study design using pretested

self-administered mailed questionnaires sent to all anesthesiologists and cardiac surgeons involved in CABG in Canada.

Results

Responses were received from anesthesiologists from all 32 hospital sites and from cardiac surgeons from 30/32 sites (94%). There was variation attributable to the hospital in transfusion triggers selected (P < 0.0001). For patients who had uncomplicated CABG surgery, the range of transfusion triggers among hospitals for the intraoperative and postoperative case scenarios were 61 to 80 g·L-1 and 64 to 80 g·L-1, respectively. The hospital accounted for 20% of the variation in the transfusion practice intraoperatively and postoperatively. The remainder of the variation was attributable to the individual physician. Academic affiliation and the number of surgical cases performed at the hospital were not significant factors impacting on the transfusion triggers selected

Conclusion

This is the first study to quantify the variation in red cell transfusion practices according to individual physicians and the hospital. The variation attributed to the hospital is significant. The explanation for the variation in transfusion decisions that relate to the hospital needs to be explored further in order to help optimize transfusion practice.

Résumé

Objectif

La variation entre les hôpitaux en ce qui touche aux pratiques transfusionnelles a été précédemment décrite, mais la proportion de cette variation imputable aux hôpitaux ne l’a pas encore été. L’objectif de ce compte-rendu était de quantifier la variation entre les hôpitaux dans les pratiques transfusionnelles périopératoires de globules rouges chez les patients subissant un pontage aortocoronarien (PAC).

Méthode

Nous avons utilisé un concept d’étude transversale en nous basant sur des questionnaires pré-testés et auto-administrés envoyés à tous les anesthésiologistes et les chirurgiens cardiaques pratiquant des PAC au Canada.

Résultats

Des réponses ont été reçues d’anesthésiologistes des 32 centres hospitaliers et de chirurgiens cardiaques de 30/32 sites (94 %). Une variation imputable à l’hôpital a été observée dans les seuils d’amorce de transfusion choisis (P < 0,0001). Chez les patients ayant une chirurgie PAC sans complication, la gamme de seuils transfusionnels entre les hôpitaux pour les scénarios de cas peropératoire et postopératoire allait de 61 à 80 g·L-1 et de 64 à 80 g·L-1, respectivement. L’hôpital était responsable de 20 % de la variation dans la pratique transfusionnelle peropératoire et postopératoire. Le reste de la variation était imputable au médecin lui-même. L’affiliation universitaire et le nombre de cas chirurgicaux effectués à l’hôpital n’ont pas constitué de facteurs significatifs ayant un impact sur les seuils de transfusion choisis.

Conclusion

Cette étude est la première à quantifier la variation dans les pratiques de transfusion de globules rouges selon les médecins eux-mêmes et l’hôpital. La variation attribuée à l’hôpital est significative. L’explication pour la variation dans les décisions de transfusion liées à l’hôpital doit être approfondie afin d’améliorer la pratique de la transfusion.

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Authors

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Correspondence to Nadine Shehata.

Additional information

Funding: This study was supported by grant XT00045 from the Canadian Blood Services’ Research and Development Program, Canada. Canadian Blood Services as a funding agency did not have any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Dr. Hébert holds the University of Ottawa Research Chair in Transfusion and Critical Care Medicine. Dr. Naglie is partially supported by the Mary Trimmer Chair in Geriatric Medicine Research, University of Toronto.

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Shehata, N., Wilson, K., Mazer, C.D. et al. The proportion of variation in perioperative transfusion decisions in Canada attributable to the hospital. Can J Anesth 54, 902 (2007). https://doi.org/10.1007/BF03026794

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  • DOI: https://doi.org/10.1007/BF03026794

Keywords

  • Transfusion Rate
  • Comorbid Illness
  • Hospital Site
  • Base Case Scenario
  • Transfusion Practice