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Large Variation in Blood Transfusion Use After Colorectal Resection: A Call to Action.
- Source :
-
Diseases of the colon and rectum [Dis Colon Rectum] 2016 May; Vol. 59 (5), pp. 411-8. - Publication Year :
- 2016
-
Abstract
- Background: Perioperative blood transfusions are associated with an increased risk of adverse postoperative outcomes through immunomodulatory effects.<br />Objective: The purpose of this study was to identify factors associated with variation in blood transfusion use after elective colorectal resection and associated postoperative infectious complications<br />Design: This was a retrospective cohort study.<br />Settings: The study included elective colorectal resections in New York State from 2001 to 2013.<br />Patients: The study cohort consists of 125,160 colorectal resections. Patients who were admitted nonelectively or who were admitted before the date of surgery were excluded.<br />Main Outcome Measures: Receipt of a perioperative allogeneic red blood cell transfusion and the secondary end points of postoperative pneumonia, surgical site infection, intra-abdominal abscess, and sepsis were measured.<br />Results: The overall rate of perioperative blood transfusion for the study cohort was 13.9%. The unadjusted blood transfusion rates ranged from 2.4% to 58.7% for individual surgeons and 2.9% to 32.8% for individual hospitals. After controlling for patient-, surgeon-, and hospital-level factors in a 3-level mixed-effects multivariable model, significant variation was still present across both surgeons (p < 0.0001) and hospitals (p < 0.0001), with a 16.8-fold difference in adjusted blood transfusion rates across surgeons and a 13.2-fold difference in adjusted blood transfusion rates across hospitals. Receipt of a blood transfusion was also independently associated with pneumonia (OR = 3.23 (95% CI, 2.92-3.57)), surgical site infection (OR = 2.27 (95% CI, 2.14-2.40)), intra-abdominal abscess (OR = 2.72 (95% CI, 2.41-3.07)), and sepsis (OR = 4.51 (95% CI, 4.11-4.94)).<br />Limitations: Limitations include the retrospective design and the possibility of miscoding within administrative data.<br />Conclusions: Large surgeon- and hospital-level variations in perioperative blood transfusion use for patients undergoing colorectal resection are present despite controlling for patient-, surgeon-, and hospital-level factors. In addition, receipt of a blood transfusion was independently associated with an increased risk of postoperative infectious complications. These findings support the creation and implementation of perioperative blood transfusion protocols aimed at limiting unwarranted variation.
- Subjects :
- Abdominal Abscess etiology
Adult
Aged
Aged, 80 and over
Elective Surgical Procedures
Female
Humans
Logistic Models
Male
Middle Aged
New York
Pneumonia etiology
Propensity Score
Retrospective Studies
Risk Factors
Sepsis etiology
Surgical Wound Infection etiology
Colectomy
Erythrocyte Transfusion adverse effects
Erythrocyte Transfusion statistics & numerical data
Healthcare Disparities statistics & numerical data
Postoperative Complications etiology
Practice Patterns, Physicians' statistics & numerical data
Rectum surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1530-0358
- Volume :
- 59
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Diseases of the colon and rectum
- Publication Type :
- Academic Journal
- Accession number :
- 27050603
- Full Text :
- https://doi.org/10.1097/DCR.0000000000000588