Featured Research

from universities, journals, and other organizations

Rates of blood transfusions for coronary artery bypass graft surgery varies widely among US hospitals

Date:
October 12, 2010
Source:
JAMA and Archives Journals
Summary:
A study that includes data on more than 100,000 patients who underwent coronary artery bypass graft surgery finds that there is wide variability among hospitals in the US on the use of blood transfusions, without a large difference in the rate of death, suggesting that many transfusions may be unnecessary, according to a new study.

A study that includes data on more than 100,000 patients who underwent coronary artery bypass graft surgery finds that there is wide variability among hospitals in the U.S. on the use of blood transfusions, without a large difference in the rate of death, suggesting that many transfusions may be unnecessary, according to a study in the October 13 issue of JAMA.

Related Articles


"Patients who undergo cardiac surgery receive a significant proportion of the 14 million units of allogeneic [taken from a different individual] red blood cells (RBCs) transfused annually in the United States," the authors write. "Perioperative [around the time of surgery] blood transfusions are costly and have safety concerns. As a result, there have been multiple initiatives to reduce transfusion use. However, the degree to which perioperative transfusion rates vary among hospitals is unknown."

Elliott Bennett-Guerrero, M.D., of Duke University Medical Center, Durham, N.C., and colleagues conducted a study to assess the use of RBC, fresh-frozen plasma, and platelet transfusions in coronary artery bypass graft (CABG) surgery in current practice, and to determine the degree to which transfusion practices vary among U.S. hospitals. The study included 102,470 patients undergoing CABG surgery during 2008 at 798 sites in the United States.

The researchers found significant variability in the observed hospital-specific transfusion rates for all 3 blood products among the patients and hospitals included in the study. To ensure that between-center differences would not be dominated by random statistical variation, the researchers also analyzed the subset of hospitals performing at least 100 eligible on-pump CABG operations during the year. At these 408 sites (n = 82,446 cases), the frequency of blood transfusion rates ranged from 7.8 percent to 92.8 percent for RBCs, 0 percent to 97.5 percent for fresh-frozen plasma, and 0.4 percent to 90.4 percent for platelets.

"Multivariate analysis including data from all 798 sites (102,470 cases) revealed that after adjustment for patient-level risk factors, hospital transfusion rates varied by geographic location, academic status, and hospital volume. However, these 3 hospital characteristics combined only explained 11.1 percent of the variation in hospital risk-adjusted RBC usage," the authors write.

There was no significant association between hospital-specific RBC transfusion rates and all-cause mortality.

"As is the case in other areas of medicine, the degree of variability in clinical practice we observed represents a potential quality improvement opportunity. This is particularly complex in relation to transfusion practice in CABG surgery. The decision to transfuse has multiple triggers, resulting from a wide array of clinical scenarios and the consequent inability to apply standardized algorithms. The multiplicity of health care practitioners in CABG surgery care generates differences of opinion about safety and efficacy. Transfusion thresholds will change during the course of care; the threshold for a rapidly bleeding patient is different than for a stable patient postoperatively. Improvement in quality related to transfusion practice in CABG surgery is a multifactorial, complex but critically important, challenge," the researchers write.

Editorial: Blood Transfusion as a Quality Indicator in Cardiac Surgery

In an accompanying editorial, Aryeh S. Shander, M.D., of Englewood Hospital and Medical Center, Englewood, N.J., and Lawrence T. Goodnough, M.D., of the Stanford University School of Medicine, Stanford, Calif., write that this study provides a snapshot of transfusion practices in a subset of patients undergoing cardiac surgery across the United States.

"The data showing highly variable transfusion rates are disconcerting. Yet despite magnitudes of differences between hospitals in terms of RBC transfusion rates, there were no significant differences in mortality rates between the hospitals. The absence of differences in mortality among centers with varying transfusion rates strongly suggests inappropriate transfusions."


Story Source:

The above story is based on materials provided by JAMA and Archives Journals. Note: Materials may be edited for content and length.


Journal References:

  1. E. Bennett-Guerrero, Y. Zhao, S. M. O'Brien, T. B. Ferguson, E. D. Peterson, J. S. Gammie, H. K. Song. Variation in Use of Blood Transfusion in Coronary Artery Bypass Graft Surgery. JAMA: The Journal of the American Medical Association, 2010; 304 (14): 1568 DOI: 10.1001/jama.2010.1406
  2. A. S. Shander, L. T. Goodnough. Blood Transfusion as a Quality Indicator in Cardiac Surgery. JAMA: The Journal of the American Medical Association, 2010; 304 (14): 1610 DOI: 10.1001/jama.2010.1483

Cite This Page:

JAMA and Archives Journals. "Rates of blood transfusions for coronary artery bypass graft surgery varies widely among US hospitals." ScienceDaily. ScienceDaily, 12 October 2010. <www.sciencedaily.com/releases/2010/10/101012163254.htm>.
JAMA and Archives Journals. (2010, October 12). Rates of blood transfusions for coronary artery bypass graft surgery varies widely among US hospitals. ScienceDaily. Retrieved November 23, 2014 from www.sciencedaily.com/releases/2010/10/101012163254.htm
JAMA and Archives Journals. "Rates of blood transfusions for coronary artery bypass graft surgery varies widely among US hospitals." ScienceDaily. www.sciencedaily.com/releases/2010/10/101012163254.htm (accessed November 23, 2014).

Share This


More From ScienceDaily



More Health & Medicine News

Sunday, November 23, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

WFP: Ebola Risks Heightened Among Women Throughout Africa

WFP: Ebola Risks Heightened Among Women Throughout Africa

AFP (Nov. 21, 2014) Having children has always been a frightening prospect in Sierra Leone, the world's most dangerous place to give birth, but Ebola has presented an alarming new threat for expectant mothers. Duration: 00:37 Video provided by AFP
Powered by NewsLook.com
Could Your Genes Be The Reason You're Single?

Could Your Genes Be The Reason You're Single?

Newsy (Nov. 21, 2014) Researchers in Beijing discovered a gene called 5-HTA1, and carriers are reportedly 20 percent more likely to be single. Video provided by Newsy
Powered by NewsLook.com
Raw: Paralyzed Marine Walks With Robotic Braces

Raw: Paralyzed Marine Walks With Robotic Braces

AP (Nov. 21, 2014) Marine Corps officials say a special operations officer left paralyzed by a sniper's bullet in Afghanistan walked using robotic leg braces in a ceremony to award him a Bronze Star. (Nov. 21) Video provided by AP
Powered by NewsLook.com
Milestone Birthdays Can Bring Existential Crisis, Study Says

Milestone Birthdays Can Bring Existential Crisis, Study Says

Newsy (Nov. 21, 2014) Researchers find that as people approach new decades in their lives they make bigger life decisions. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins