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A two-institution study of transfusion practice in 78 consecutive adult elective open-heart procedures
L T Goodnough1, M F Johnston, T Shah
1Department of Medicine, Case Western Reserve University, Cleveland, Ohio.
Insights
Transfusion practices in cardiac surgery vary significantly between hospitals, often reflecting institutional habits rather than patient need. Further multi-center studies are required to standardize homologous blood use and optimize patient care.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Health Services Research
Background:
- Blood salvage and conservative transfusion practices have reduced homologous blood use in cardiac surgery.
- Previous reports indicated homologous blood exposure in as few as 10% of elective cardiac revascularization patients.
Purpose of the Study:
- To identify and compare current prevailing transfusion practices across different institutions in adult elective open-heart surgery.
- To determine the factors influencing homologous blood transfusion decisions.
Main Methods:
- Prospective audit of 78 consecutive adult elective open-heart surgery cases across two institutions.
- Data collected included patient demographics, surgical details, intraoperative blood salvage, and preoperative/nadir hematocrit and platelet counts.
Main Results:
- Institution 1 transfused 73% of patients with an average of 5.0 homologous blood units (HBs), while Institution 2 transfused 52% with an average of 2.9 HBs (P < 0.05).
- Factors influencing transfusion varied between institutions, suggesting practice patterns rather than clinical need.
- Autologous blood pre-deposit was found to be underutilized.
Conclusions:
- Homologous blood exposure determinants are inconsistent between institutions, indicating prevailing practice influences transfusion decisions.
- A multi-institution audit is necessary to standardize transfusion practices in cardiac revascularization.
- Opportunities exist to increase the use of autologous blood pre-deposit in open-heart surgery.
Abstract:
Blood salvage techniques and increasingly conservative physician transfusion practice in cardiac surgery have led to reports of homologous blood exposure in as few as 10% of patients having elective cardiac revascularization surgery (Ann Thorac Surg 1985;40:380). To identify current prevailing transfusion practice between centers, the authors prospectively audited 49 and 29 consecutive adult elective open-heart surgery cases (78 total) at two centers. Thirty-six of 49 patients (73%) received 245 homologous blood units (HBs) at institution 1 (m = 5.0). Fifteen of 29 (52%) received 84 HBs at institution 2 (m = 2.9, P less than 0.05). Sex, age, duration of surgery, intraoperative blood salvaged, preoperative hematocrit (Hct), nadir Hct, and nadir platelet counts, and the surgeon were all found to be determinants of transfusion practice at institution 1 but not at the other. The data indicate that (1) determinants of homologous blood exposure are not consistent between institutions and instead reflect "prevailing practice" rather than need; (2) a prospective multi-institution audit of prevailing transfusion practice in cardiac revascularization is needed to address this; (3) autologous blood pre-deposit is underused in open-heart surgery.