Variation in Red Blood Cell Transfusion Practices During Cardiac Operations Among Centers in Maryland: Results From a State Quality-Improvement Collaborative

Abstract

Significant variation in intercenter RBC transfusion practices exists for both intraoperative and postoperative transfusions, even after risk adjustment, among our state's centers. Variability in intraoperative RBC transfusion persisted across quartiles of preoperative hematocrit values.

Impact of intraoperative high‐volume autologous blood collection on allogeneic transfusion during and after cardiac surgery: a propensity score matched analysis

“…The cohorts in our study had a median TRUST score of 2, which represents a moderate (40%–60%) risk for perioperative RBC transfusion. Perioperative RBC transfusion rates in cardiac surgery were reported to be 49.5% in the state of Maryland and 40%–70% globally …”

“…We identified all patients from our institutional Society of Thoracic Surgeons (STS) database who had coronary artery bypass grafting (CABG), isolated aortic valve replacement (AVR), or combined CABG‐AVR between January 2014 and September 2017. The following patients were excluded: patients older than age 80 or younger than age 40, patients with a body mass index (BMI) greater than 45, patients taking warfarin or a novel oral anticoagulant before surgery, patients taking P2Y 12 inhibitors before surgery, patients with CPB time greater than 4 hours or less than 40 minutes, patients having emergency surgery, patients with a baseline hematocrit less than 27, and patients with a baseline platelet count less than 100 × 10/L. Patients were classified as having two full citrate‐phosphate‐dextrose bags (each bag containing a maximum of 450 mL; total >900 mL) or those who had no AWB harvest or a collected volume between 0 and 900 mL.…”

“…Avoidance of blood transfusion has important clinical and economic implications because allogeneic RBCs are strongly associated with increased risks of infection, myocardial infarction, renal dysfunction, stroke, and prolonged hospital stay . RBCs remain the most commonly transfused product during and after cardiac surgery . Although blood conservation techniques such as cell salvage and low‐volume cardiopulmonary bypass (CPB) priming maintain intraoperative hemoglobin levels, anemia can be exacerbated postoperatively due to bleeding and fluid replacement .…”

Risks of restrictive red blood cell transfusion strategies in patients with cardiovascular disease (CVD): a meta‐analysis

“…Few trials of RBC transfusion triggers have focused on patients with underlying CVD. Most available data on transfusion practices for patients either with or without CVD stem from decades‐old retrospective analyses of large electronic medical record databases (Yang et al, ; Alexander et al, ; Salisbury et al, , ; Sherwood et al, ; Magruder et al, ). These studies compare nadir haemoglobin or haematocrit values among transfused and non‐transfused patients with CVD without identifying the specific transfusion thresholds or clinical indicators used to justify RBC transfusion (Alexander et al, ; Salisbury et al, ).…”

“…These studies compare nadir haemoglobin or haematocrit values among transfused and non‐transfused patients with CVD without identifying the specific transfusion thresholds or clinical indicators used to justify RBC transfusion (Alexander et al, ; Salisbury et al, ). The majority of studies do suggest that there is significant variability in transfusion practices among different centres (Hutton et al, ; Sherwood et al, ; Magruder et al, ). However, no trials have investigated whether the risks of restrictive or liberal strategies differ in patients with CVD compared to those without known CVD or how these risks compare in CVD patients hospitalised for cardiac corrective procedures versus non‐cardiac indications.…”