什么驱动了手术后心脏手术输血率的变化?
Carrinton Mauney1, Eric Etchill2, Amanda Rea3
1Johns Hopkins University School of Medicine, Baltimore, Md.
The Journal of thoracic and cardiovascular surgery
|February 8, 2024
概括
对于心脏手术患者的医院输血率有显著差异. 通过遵守严格的血红蛋白触发值<6 g/dL,L医院输血的患者较少,证明了有效的实践变异控制.
科学领域:
- 心脏病学 心脏病学
- 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:
- 在心脏手术后的术后输血率存在显著的医院间变化.
- 了解推动这些变化的机构因素对于优化患者护理和资源配置至关重要.
研究的目的:
- 为了比较两个进行心脏手术的医院 (H和L) 之间的术后输血率.
- 确定与不同输血率相关的机构实践因素,独立于患者或手术特征.
主要方法:
- 分析了2020年2月至2022年8月期间在两个医院 (H和L) 接受常规心脏手术的成年患者.
- 患者和手术特征,血红蛋白水平和输血率进行了比较.
- 使用倾向匹配来确保患者群体的可比性.
主要成果:
- 在倾向匹配后,分析了2111名患者,H和L医院之间主要结果没有显著差异.
- 医院H为36%的患者输血,而医院L仅为12%的患者输血 (P < .001).
- L医院的输血率显著降低,特别是在血红蛋白>7.5g/dL (0.9%对27%) 的患者中,由于严格的输血触发值<6g/dL和狭窄的指示.
结论:
- 医院H和L之间输血率的差异是由于医院L严格遵守输血触发值<6g/dL.
- 与医院H相比,在L医院输血量超过这个血红蛋白值的更窄的指示有助于减少输血率.
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