红细胞输血与冠状动脉旁路在全州数据库中的机构变化
Stephen D Waterford1, Sari D Holmes2, Clifford Edwin Fonner3
1Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
The Annals of thoracic surgery
|September 22, 2023
概括
医院实践显著影响心脏手术中的红细胞 (RBC) 输血率,独立于患者因素. 这种变化凸显了机构文化对输血决策的影响,表明需要标准化的协议.
科学领域:
- 心血管外科心血管外科
- 输血医学 输血医学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 红细胞 (RBC) 输血决定在心脏手术中很常见,但表现出显著的中心间变异性.
- 了解这种变化的驱动因素对于优化患者护理和资源配置至关重要.
研究的目的:
- 调查医院特定因素与心脏手术患者的红细胞输血率之间的关联.
- 为了确定在考虑到患者特定的临床和人口学变量后,输血率的医院变化是否持续.
主要方法:
- 对全州数据库 (马里兰州心脏手术质量倡议) 的分析,包括5343名接受隔离冠状动脉旁路移植的患者 (2018年1月 - 2020年6月).
- 采用多变量后勤回归来确定红细胞输血的预测因素,包括患者的人口统计,手术前的健康状况和手术因素.
- 统计分析专门研究了医院对输血概率的独立影响.
主要成果:
- 观察到总体红细胞输血率为30.3%,在10所参与医院之间存在很大差异 (范围:11.3%-55.8%).
- 确认了红细胞输血发生率在医院水平上的显著变化 (P < .001).
- 在对患者共变量进行调整后,该医院仍然是红细胞输血的显著独立预测指标 (P < .001),并且这种变化无法通过患者年龄,血红蛋白,预测死亡风险或性别的差异来解释.
结论:
- 在全州心脏手术队列中,红细胞输血率在各医院之间存在很大变化.
- 医院特定的管理实践和机构文化似乎是红细胞输血决策的重要独立驱动因素,超出了患者层面的风险因素.
- 这些发现强调了通过标准化的机构协议和质量改善举措优化输血策略的潜力.
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