title: Institutional variability in red blood cell conservation practices for coronary artery bypass graft surgery. Institutions of the MultiCenter Study of Perioperative Ischemia Research Group.
abstract: OBJECTIVE
  To assess whether substantial institutional variability exists in red blood cell conservation practices associated with coronary artery bypass graft (CABG) surgery.
  
  
  METHODS
  Prospective, randomized patient enrollment and data collection.
  
  
  METHODS
  Twenty-four U.S. academic institutions participating in the Multicenter Study of Perioperative Ischemia.
  
  
  METHODS
  A well-defined subset of primary CABG surgery patients (n = 713) expected to be at low risk for bleeding and exposure to allogeneic transfusion.
  
  
  METHODS
  None (observational study).
  
  
  RESULTS
  Frequency of use of red blood cell conservation techniques was determined among institutions. Correlation was determined between use of each technique and transfusion of allogeneic red blood cells and between use of each technique and median institutional blood loss. Significant variability (p < 0.01) was detected in institutional transfusion practice with respect to the use of predonated autologous whole blood, normovolemic hemodilution, red cell salvage, and reinfusion of shed mediastinal blood. The frequency of institutional use of these techniques was not associated with allogeneic transfusion (r2 < 0.15) or blood loss (r2 < 0.10) in the low-risk population of patients examined.
  
  
  CONCLUSIONS
  Institutions vary significantly in perioperative blood conservation practices for CABG surgery. Further study to determine the appropriate use of these techniques is warranted.
authors.affiliation: Department of Anesthesia, Stanford University School of Medicine, CA 94305, USA.
authors.forename: E P
authors.initials: EP
authors.lastname: Stover
authors.forename: L C
authors.initials: LC
authors.lastname: Siegel
authors.forename: S C
authors.initials: SC
authors.lastname: Body
authors.forename: J
authors.initials: J
authors.lastname: Levin
authors.forename: R
authors.initials: R
authors.lastname: Parks
authors.forename: R
authors.initials: R
authors.lastname: Maddi
authors.forename: M N
authors.initials: MN
authors.lastname: D'Ambra
authors.forename: D T
authors.initials: DT
authors.lastname: Mangano
authors.forename: B D
authors.initials: BD
authors.lastname: Spiess
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D001026:Coronary Artery Bypass; D004912:Erythrocytes / Q000502:physiology*; D006400:Hematocrit; D006438:Hemodilution; D006801:Humans; D007431:Intraoperative Complications / Q000628:therapy; D007511:Ischemia / Q000209:etiology / Q000628:therapy; D011446:Prospective Studies