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Transfusion practice in coronary artery bypass surgery in Denmark: a multicenter audit
Jan J Andreasen1, Mikkel Westen, Peter A Pallesen
1Department of Cardiothoracic Surgery, Aalborg Hospital, Hobrovej, Postboks 365, DK-9100 Aalborg, Denmark. jan.jesper.andreasen@stofanet.dk
Insights
Transfusion rates for coronary artery bypass grafting (CABG) vary widely between Danish hospitals, with some patients receiving unnecessary blood transfusions. Audits reveal significant practice differences, highlighting the need for standardized transfusion protocols.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Healthcare Quality Improvement
Background:
- Allogeneic transfusion rates in coronary artery bypass grafting (CABG) show considerable variation despite existing guidelines.
- Variations in transfusion practices can impact patient outcomes and resource utilization.
Purpose of the Study:
- To evaluate and compare the use of allogeneic blood products in patients undergoing first-time CABG across four Danish hospitals.
- To identify factors contributing to variations in transfusion rates and assess the appropriateness of transfusions.
Main Methods:
- A multicenter audit of 600 patient records (150 per hospital) undergoing first-time CABG.
- Data collection included patient characteristics, preoperative, perioperative, and postoperative factors.
- Statistical analysis to determine the relative risk of allogeneic blood transfusion.
Main Results:
- Significant differences observed in preoperative antiplatelet use, antifibrinolytic use, cardiopulmonary bypass (CPB) utilization, cross-clamp time, CPB time, lowest hemoglobin during CPB, and number of distal anastomoses.
- Allogeneic red blood cell transfusion rates ranged from 30.0% to 64.2% across hospitals.
- Inappropriate transfusions were noted, with 12.1-42.7% of transfused patients discharged with hemoglobin >7 mmol/l.
- The hospital with the highest transfusion rate had a 2.1-fold increased risk of transfusion after adjusting for covariates.
Conclusions:
- Substantial variations in allogeneic blood transfusion practices exist among Danish hospitals performing CABG.
- These differences likely reflect true variations in clinical practice rather than solely patient-related factors.
- Audits provide a foundation for targeted educational initiatives to standardize transfusion practices and improve patient care.
Abstract:
Transfusion rates in coronary artery bypass grafting (CABG) continue to vary substantially, although guidelines for allogeneic transfusion have been developed. In order to evaluate ongoing transfusion practices, we performed a multicenter audit in four Danish hospitals regarding the use of allogeneic blood products among patients undergoing first-time CABG. Data on patient characteristics, peri- and postoperative factors were retrieved from 600 patient records (150 records per hospital). Substantial differences were seen regarding preoperative intake of antiplatelet drugs, perioperative use of antifibrinolytic drugs, use of cardiopulmonary bypass (CPB), cross-clamp time, time on CPB, lowest hemoglobin during CPB, and number of distal anastomoses. The percentage of patients transfused with allogeneic red blood cells ranged from 30.0% to 64.2%. Several patients (12.1-42.7%) transfused with red blood cells were discharged with a hemoglobin concentration >7 mmol/l, indicating inappropriate transfusions. The relative risk of receiving an allogeneic blood transfusion was 2.1 (95% CI: 1.6-2.7) in the hospital with the highest transfusion rate, after adjustment for patient-, drug-, and procedure-related factors. Interesting differences in transfusion rates exists in Danish hospitals and these differences may reflect true variations in transfusion practices. Audits create a basis for educational efforts among surgeons and anesthesiologists to standardize transfusion practices.
