Variation in Use of Blood Transfusion in Coronary Artery Bypass Graft Surgery
Variation in Use of Blood Transfusion in Coronary Artery Bypass Graft Surgery
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DOI：
10.1001/jama.2010.1406
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发表时间：
2010-10-13
影响因子：
120.7
通讯作者：
Song, Howard K.
中科院分区：
文献类型：
--
作者：
Bennett-Guerrero, Elliott;Zhao, Yue;Song, Howard K.
背景围手术期输血费用昂贵且存在安全问题。因此，已经采取了多项减少输血使用的举措。然而，不同医院围手术期输血率的差异程度尚不清楚。 目的 评估接受冠状动脉搭桥术 (CABG) 手术的患者使用同种异体红细胞 (RBC)、新鲜冷冻血浆和血小板输注的医院水平差异。 设计、环境和患者 2008 年期间在美国 798 个地点接受体外循环初次孤立 CABG 手术的 102 470 名患者组成的观察队列各州，向胸外科医生协会成人心脏手术数据库提供数据。主要结果指标围手术期（术中和术后）输注红细胞、新鲜冷冻血浆和血小板。结果在至少进行 100 例体外循环 CABG 手术（408 个部位 82 446 例）的医院中，红细胞输血率在 7.8% 至 92.8% 之间，新鲜冰冻血浆为 0% 至 97.5%，血小板为 0.4% 至 90.4%。包括来自所有 798 个地点（102 470 例）的数据的多变量分析显示，在调整患者层面的危险因素后，医院输血率因地理位置 (P=.007)、学术地位 (P=.03) 和医院规模 (P
Context Perioperative blood transfusions are costly and have safety concerns. As a result, there have been multiple initiatives to reduce transfusion use. However, the degree to which perioperative transfusion rates vary among hospitals is unknown.Objective To assess hospital-level variation in use of allogeneic red blood cell (RBC), fresh-frozen plasma, and platelet transfusions in patients undergoing coronary artery bypass graft (CABG) surgery.Design, Setting, and Patients An observational cohort of 102 470 patients undergoing primary isolated CABG surgery with cardiopulmonary bypass during calendar year 2008 at 798 sites in the United States, contributing data to the Society of Thoracic Surgeons Adult Cardiac Surgery Database.Main Outcome Measures Perioperative (intraoperative and postoperative) transfusion of RBCs, fresh-frozen plasma, and platelets.Results At hospitals performing at least 100 on-pump CABG operations (82 446 cases at 408 sites), the rates of blood transfusion ranged from 7.8% to 92.8% for RBCs, 0% to 97.5% for fresh-frozen plasma, and 0.4% to 90.4% for platelets. Multivariable analysis including data from all 798 sites (102 470 cases) revealed that after adjustment for patient-level risk factors, hospital transfusion rates varied by geographic location (P=.007), academic status (P=.03), and hospital volume (P