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Red cell transfusions in coronary artery bypass surgery (DRGs 106 and 107)
D M Surgenor1, E L Wallace, W H Churchill
1Center for Blood Research, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Insights
Red cell transfusion practices varied significantly between hospitals for coronary artery bypass graft (CABG) patients. Hospital-specific factors, not surgical details, appeared to drive transfusion decisions.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Health Services Research
Background:
- Red blood cell transfusion is common in coronary artery bypass graft (CABG) surgery.
- Variations in transfusion practices exist, impacting patient outcomes and resource utilization.
Purpose of the Study:
- To investigate red cell transfusion practices in CABG patients across multiple hospitals.
- To identify factors influencing transfusion decisions, including patient demographics, surgical procedure, and hospital-level variations.
Main Methods:
- Retrospective analysis of 3216 CABG patient records from 11 hospitals in 1988.
- Stratification by Diagnosis Related Group (DRG 106 vs. 107) and International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) surgical procedure codes.
- Comparison of transfusion rates, units transfused, patient age, length of stay, and mortality between DRGs and hospitals.
Main Results:
- Patients in DRG 106 (CABG without catheterization) had higher transfusion rates, more units transfused, greater age, longer stays, and higher mortality than DRG 107 patients.
- Female patients were more likely to receive transfusions and received more units than male patients.
- Significant hospital-level differences were observed in the percentage of patients transfused, but not in the mean units per transfused patient within specific surgical classes.
Conclusions:
- Hospital-specific factors, yet to be identified, significantly influenced red cell transfusion decisions for CABG patients.
- Transfusion practices appear more dependent on institutional norms than on specific surgical characteristics or patient DRGs.
- Further research is needed to elucidate the 'circumstances' within hospitals that drive these transfusion variations.
Abstract:
To study red cell transfusion practice in 3216 coronary artery bypass graft (CABG) cases in 11 hospitals in 1988, abstracted patient records were stratified by diagnosis related group (DRG) (that is, DRG 106, coronary artery bypass without catheterization, or DRG 107, coronary artery bypass with catheterization) and International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) surgical procedure code. Means of units per transfused patient, age and length of stay, and in-hospital mortality rates were significantly greater for patients in DRG 106 than DRG 107. Gender was a significant factor for transfusion outcomes; female patients were more likely to undergo transfusion, and, when transfused, they received more units of red cells than male patients. For a given DRG/ICD-9-CM surgical procedure class, significant differences were found between hospitals in the percentage of patients transfused, but not in mean units of red cells per transfused patient. However, within individual hospitals, the proportion of patients transfused and the number of units per transfused patient did not vary significantly across DRG/ICD-9-CM procedure classes. These results suggest that circumstances operating within a hospital, still to be identified, had more influence on transfusion decisions than the nature of the surgical intervention.