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Incidence and Temporal Changes of Transfusion and Coagulation Management in Cardiac Surgery: Insights From the
Caroline M Schaap1, Jimmy Schenk2, Susanne Eberl3
1Department of Intensive Care Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
Insights
Perioperative transfusion rates for red blood cells (RBCs) and other blood products in Dutch cardiac surgery have risen significantly between 2016 and 2023. This increase shows considerable variation among hospitals, independent of patient factors.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Health Services Research
Background:
- Perioperative transfusion is common in cardiac surgery.
- Understanding transfusion practices, variability, and trends is crucial for patient outcomes.
- The Netherlands Heart Registration (NHR) provides a national dataset for such analyses.
Purpose of the Study:
- To describe perioperative transfusion rates in Dutch cardiac surgery.
- To investigate hospital variability and temporal trends in transfusion practices.
- To explore the association between red blood cell (RBC) transfusion and patient/procedural characteristics.
Main Methods:
- Nationwide retrospective cohort study utilizing NHR data.
- Inclusion of adult patients undergoing cardiac surgery across all 16 Dutch centers (2016-2023).
- Analysis of transfusion rates for RBCs, plasma, platelets, and other hemostatic agents, alongside interhospital variability and temporal trends.
Main Results:
- Overall transfusion rates: RBCs (30.6%), plasma (11.0%), platelets (20.3%).
- Significant intercenter variability in transfusion rates was observed.
- Annual transfusion rates increased for most products, including RBCs (OR 1.02), with a similar trend persisting after adjusting for patient/procedural factors (aOR 1.03).
Conclusions:
- Perioperative transfusion rates in Dutch cardiac surgery have increased and exhibit substantial intercenter variability.
- The rise in RBC transfusions was not fully explained by changes in measured patient or procedural characteristics.
- Continuous monitoring of transfusion practices is essential to understand temporal trends and variations in clinical practice.
Objectives:
To describe perioperative transfusion rates, hospital variability, temporal trends, and the association between red blood cell (RBC) transfusion and predefined risk factors in Dutch cardiac surgery.
Design:
Nationwide retrospective cohort study.
Setting:
All 16 cardiac surgery centers in the Netherlands, 2016-2023.
Participants:
Adults undergoing cardiac surgery recorded in the mandatory Netherlands Heart Registration (NHR), between 2016 and 2023 (N = 110,366).
Interventions:
None.
Measurements And Main Results:
The primary outcome were transfusion rates of RBCs, plasma, platelets, prothrombin complex concentrate, fibrinogen concentrate, and recombinant factor VIIa. Secondary outcomes included interhospital variability and temporal trends. Transfusion rates among patients with available data were 30.6% for RBCs, 11.0% for plasma, 20.3% for platelets, 7.4% for prothrombin complex concentrate, 13.5% for fibrinogen concentrate, and 0.5% for recombinant factor VIIa. Significant variability existed between centers. Annual transfusion rates increased for almost all products: RBCs (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.02-1.03), plasma (OR 1.08, 95% CI 1.07-1.09), platelets (OR 1.09, 95% CI 1.08-1.10), PCC (OR 1.10, 95% CI 1.09-1.11), fibrinogen (OR 1.15, 95% CI 1.14-1.16). In exploratory analyses, adjustment for patient and procedural characteristics showed a similar temporal trend in RBC transfusion (adjusted OR 1.03, 95% CI 1.02-1.04) per year.
Conclusions:
Perioperative transfusion rates in Dutch cardiac surgery have increased and have substantial intercenter variability. The observed increase in RBC transfusions was not fully reflected by changes in measured patient and procedural characteristics. These findings highlight the importance of continuous monitoring of transfusion practices to better understand temporal trends and variation in clinical practice.
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