Variation in Platelet Transfusion Practices in Cardiac Surgery

Area of Science:

• Cardiovascular Surgery
• Transfusion Medicine
• Healthcare Quality Improvement

Background:

• Red blood cell transfusion morbidity in cardiac surgery is known, but platelet transfusion impacts are less understood.
• Conflicting results from prior studies highlight the need for further investigation into platelet transfusion outcomes.
• Platelet transfusion practices vary significantly across institutions, impacting patient care.

Purpose of the Study:

• To investigate the impact of platelet transfusion on patient outcomes after cardiac surgery.
• To analyze variations in platelet transfusion practices across multiple institutions in Maryland.
• To identify associations between platelet transfusion and 30-day mortality and postoperative complications.

Main Methods:

• Retrospective analysis of 10,478 patients undergoing isolated coronary artery bypass from the Maryland Cardiac Surgery Quality Initiative database.
• Comparison of platelet transfusion practices across 10 participating centers.
• Multivariate logistic regression to assess the relationship between platelet transfusion and adverse outcomes.

Main Results:

• Platelet transfusion rates varied widely between institutions (4.4% to 24.7%), persisting after propensity score matching.
• For patients on preoperative antiplatelet therapy, transfusion rates ranged from 8.5% to 46.4%.
• Platelet transfusion was associated with increased 30-day mortality (OR 2.43), pneumonia (OR 2.21), prolonged intubation (OR 2.05), and readmission (OR 1.43).

Conclusions:

• Significant institutional variation in platelet transfusion rates exists, even after risk factor adjustment.
• This variation may correlate with increased mortality and length of stay.
• Further research and practice standardization are needed to mitigate risks and optimize resource use in platelet transfusion.