title: The Collaborative Hospital Transfusion Study: variations in use of autologous blood account for hospital differences in red cell use during primary hip and knee surgery.
abstract: BACKGROUND
  Red cell use in patients undergoing Diagnosis Related Group (DRG) 209 procedures (major joint and limb reconstruction procedures of the lower extremities) has been shown to have large, unexplained interhospital variations.
  
  
  METHODS
  Abstracted records of 2590 consecutive DRG 209 patients at five university hospitals from January 1992 to December 1993 were stratified by procedure and preoperative blood deposit status. Patient characteristics and transfusion and in-hospital outcomes were compared across hospitals.
  
  
  RESULTS
  Blood use among patients who did not preoperatively deposit blood was similar across hospitals. Significant differences were found across hospitals for total hip replacement patients in the percentage of patients preoperatively depositing blood (59-80%), percentage of patients receiving transfusion(s) (51 to > 99%), the mean number of units collected per patient (1.6-2.9), and the mean number of unused autologous units per 100 patients (1-185). No significant differences were found in the percentage of those who deposited blood and then required allogeneic units. There was little variability in length of hospital stay or in last hematocrits. Findings were similar for total knee replacement patients.
  
  
  CONCLUSIONS
  Interhospital variations in red cell use for primary total hip and knee reconstruction are primarily due to hospital-specific differences in autologous blood collection and transfusion.
authors.affiliation: Center for Blood Research, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: W H
authors.initials: WH
authors.lastname: Churchill
authors.forename: S
authors.initials: S
authors.lastname: McGurk
authors.forename: R H
authors.initials: RH
authors.lastname: Chapman
authors.forename: E L
authors.initials: EL
authors.lastname: Wallace
authors.forename: M F
authors.initials: MF
authors.lastname: Bertholf
authors.forename: L T
authors.initials: LT
authors.lastname: Goodnough
authors.forename: K J
authors.initials: KJ
authors.lastname: Kao
authors.forename: J D
authors.initials: JD
authors.lastname: Olson
authors.forename: R D
authors.initials: RD
authors.lastname: Woodson
authors.forename: D M
authors.initials: DM
authors.lastname: Surgenor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D001804:Blood Transfusion, Autologous / Q000706:statistics & numerical data*; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012044:Regression Analysis; D016896:Treatment Outcome