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. 2017 Sep;125(3):975-980.
doi: 10.1213/ANE.0000000000002277.

Organizational Contributors to the Variation in Red Blood Cell Transfusion Practices in Cardiac Surgery: Survey Results From the State of Michigan

Anton Camaj  1 , Darin B Zahuranec, Gaetano Paone, Barbara R Benedetti, Warren D Behr, Marc A Zimmerman, Min Zhang, Robert S Kramer, Jason Penn, Patricia F Theurer, Theron A Paugh, Milo Engoren, Alphonse DeLucia 3rd, Richard L Prager, Donald S Likosky; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative
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Organizational Contributors to the Variation in Red Blood Cell Transfusion Practices in Cardiac Surgery: Survey Results From the State of Michigan

Anton Camaj et al. Anesth Analg. 2017 Sep.

Abstract

Background: While large volumes of red blood cell transfusions are given to preserve life for cardiac surgical patients, indications for lower volume transfusions (1-2 units) are less well understood. We evaluated the relationship between center-level organizational blood management practices and center-level variability in low volume transfusion rates.

Methods: All 33 nonfederal, Michigan cardiac surgical programs were surveyed about their blood management practices for isolated, nonemergent coronary bypass procedures, including: (1) presence and structure of a patient blood management program, (2) policies and procedures, and (3) audit and feedback practices. Practices were compared across low (N = 14, rate: 0.8%-10.1%) and high (N = 18, rate: 11.0%-26.3%) transfusion rate centers.

Results: Thirty-two (97.0%) of 33 institutions participated in this study. No statistical differences in organizational practices were identified between low- and high-rate groups, including: (1) the membership composition of patient blood management programs among those reporting having a blood management committee (P= .27-1.0), (2) the presence of available red blood cell units within the operating room (4 of 14 low-rate versus 2 of 18 high-rate centers report that they store no units per surgical case, P= .36), and (3) the frequency of internal benchmarking reporting about blood management audit and feedback practices (low rate: 8 of 14 versus high rate: 9 of 18; P= .43).

Conclusions: We did not identify meaningful differences in organizational practices between low- and high-rate intraoperative transfusion centers. While a larger sample size may have been able to identify differences in organizational practices, efforts to reduce variation in 1- to 2-unit, intraoperative transfusions may benefit from evaluating other determinants, including organizational culture and provider transfusion practices.

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Conflict of interest statement

All other authors declare that they have no conflicts of interest relevant to the manuscript.

CONFLICTS OF INTEREST: Dr. Likosky is supported in part by grant numbers R01HS022535 and R03HS022909 from the Agency for Healthcare Research and Quality (AHRQ). Anton Camaj is supported by grant number 5TL1TR000435 from the National Institutes of Health (NIH). Dr. Zahuranec is supported by grant KAG038731 (NIH). The opinions expressed in this document are those of the authors and do not reflect the official position of the AHRQ, NIH, or the U.S. Department of Health and Human Services.

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