The specific hospital significantly affects red cell and component transfusion practice in coronary artery bypass graft surgery: a study of five hospitals

Area of Science:

• Cardiovascular Surgery
• Transfusion Medicine
• Health Services Research

Background:

• Significant interhospital variability in blood transfusion practices during coronary artery bypass graft (CABG) surgery has been observed.
• The root causes of these disparities in transfusion rates remain unidentified.

Purpose of the Study:

• To investigate the factors contributing to interhospital differences in blood transfusion practices for CABG surgery.
• To determine whether hospital-specific effects or surgeon-level variations are responsible for observed transfusion rate discrepancies.

Main Methods:

• Analysis of 3217 consecutive CABG cases from five university teaching hospitals (1992-1993).
• Stratification of data by hospital, revascularization conduit, patient sex, and other relevant factors.
• Utilized forward two-step logistic regression to assess the impact of hospital and patient factors on red cell transfusion likelihood.

Main Results:

• A significant effect of the specific hospital on the likelihood of red cell transfusion was identified (p < 0.001).
• Variations in red cell transfusion rates ranged from 109 to 457 units per hundred cases among hospitals for a specific patient subgroup.
• Transfusion rates for all blood components also varied widely by hospital (324 to 1019 units per hundred cases).
• Interhospital differences could not be explained by variations in practice among surgeons within the same institution.

Conclusions:

• The specific hospital environment significantly influences blood transfusion practices in CABG surgery.
• These institutional effects are likely ingrained due to training or hierarchical factors within hospitals.
• Findings underscore the need for standardized transfusion protocols and institutional-level interventions to reduce unnecessary variability.