title: A two-institution study of transfusion practice in 78 consecutive adult elective open-heart procedures.
abstract: Blood salvage techniques and increasingly conservative physician transfusion practice in cardiac surgery have led to reports of homologous blood exposure in as few as 10% of patients having elective cardiac revascularization surgery (Ann Thorac Surg 1985;40:380). To identify current prevailing transfusion practice between centers, the authors prospectively audited 49 and 29 consecutive adult elective open-heart surgery cases (78 total) at two centers. Thirty-six of 49 patients (73%) received 245 homologous blood units (HBs) at institution 1 (m = 5.0). Fifteen of 29 (52%) received 84 HBs at institution 2 (m = 2.9, P less than 0.05). Sex, age, duration of surgery, intraoperative blood salvaged, preoperative hematocrit (Hct), nadir Hct, and nadir platelet counts, and the surgeon were all found to be determinants of transfusion practice at institution 1 but not at the other. The data indicate that (1) determinants of homologous blood exposure are not consistent between institutions and instead reflect "prevailing practice" rather than need; (2) a prospective multi-institution audit of prevailing transfusion practice in cardiac revascularization is needed to address this; (3) autologous blood pre-deposit is underused in open-heart surgery.
authors.affiliation: Department of Medicine, Case Western Reserve University, Cleveland, Ohio.
authors.forename: L T
authors.initials: LT
authors.lastname: Goodnough
authors.forename: M F
authors.initials: MF
authors.lastname: Johnston
authors.forename: T
authors.initials: T
authors.lastname: Shah
authors.forename: A
authors.initials: A
authors.lastname: Chernosky
mesh_terms: D001803:Blood Transfusion / Q000706:statistics & numerical data*; D001804:Blood Transfusion, Autologous / Q000706:statistics & numerical data; D017707:Erythrocyte Transfusion; D005260:Female; D006350:Heart Valve Prosthesis; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009204:Myocardial Revascularization; D009820:Ohio; D013903:Thoracic Surgery / Q000379:methods*