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Institutional Red Blood Cell Transfusion Rates Are Correlated Following Endovascular and Surgical Cardiovascular Procedures: Evidence That Local Culture Influences Transfusion Decisions.
- Source :
-
Journal of the American Heart Association [J Am Heart Assoc] 2020 Nov 17; Vol. 9 (22), pp. e016232. Date of Electronic Publication: 2020 Nov 03. - Publication Year :
- 2020
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Abstract
- Background The relationship between local hospital culture and transfusion rates following endovascular and surgical cardiovascular procedures has not been well studied. Methods and Results Patients undergoing coronary revascularization, aortic valve replacement, lower extremity peripheral vascular intervention, or carotid artery revascularization from up to 852 US hospitals in the Nationwide Readmissions Database were identified. Crude and risk-standardized red blood cell transfusion rates were determined for each procedure. Pearson correlation coefficients were calculated between respective procedural transfusion rates. Median odds ratios were estimated to reflect between-hospital variability in red blood cell transfusion rates following the same procedure for a given patient. There was wide variation in red blood cell transfusion rates across different procedures, from 2% following carotid endarterectomy to 29% following surgical aortic valve replacement. For surgical and endovascular modalities, transfusion rates at the same hospital were highly correlated for aortic valve replacement ( r =0.67; P <0.001), moderately correlated for coronary revascularization ( r =0.56; P <0.001) and peripheral vascular intervention ( r =0.51; P <0.001), and weakly correlated for carotid artery revascularization ( r =0.19, P <0.001). Median odds ratios were all >2, highest for coronary artery bypass graft surgery and surgical aortic valve replacement, indicating substantial site variation in transfusion rates. Conclusions After adjustment for patient-related factors, wide variation in red blood cell transfusion rates remained across surgical and endovascular procedures employed for the same cardiovascular condition. Transfusion rates following these procedures are highly correlated at individual hospitals and vary widely across hospitals. In aggregate, these findings suggest that local institutional culture significantly influences the decision to transfuse following invasive cardiovascular procedures and highlight the need for randomized data to inform such decisions.
- Subjects :
- Clinical Decision-Making
Female
Hospital Bed Capacity
Humans
Male
Odds Ratio
Patient Readmission
Patient Selection
Procedures and Techniques Utilization
United States
Cardiac Surgical Procedures statistics & numerical data
Endovascular Procedures statistics & numerical data
Erythrocyte Transfusion statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 2047-9980
- Volume :
- 9
- Issue :
- 22
- Database :
- MEDLINE
- Journal :
- Journal of the American Heart Association
- Publication Type :
- Academic Journal
- Accession number :
- 33140685
- Full Text :
- https://doi.org/10.1161/JAHA.119.016232