Transfusion practice in coronary artery bypass surgery in Denmark: a multicenter audit.
Transfusion rates in coronary artery bypass grafting (CABG) continue to vary substantially, although guidelines for allogeneic transfusion have been developed. In order to evaluate ongoing transfusion practices, we performed a multicenter audit in four Danish hospitals regarding the use of allogeneic blood products among patients undergoing first-time CABG. Data on patient characteristics, peri- and postoperative factors were retrieved from 600 patient records (150 records per hospital). Substantial differences were seen regarding preoperative intake of antiplatelet drugs, perioperative use of antifibrinolytic drugs, use of cardiopulmonary bypass (CPB), cross-clamp time, time on CPB, lowest hemoglobin during CPB, and number of distal anastomoses. The percentage of patients transfused with allogeneic red blood cells ranged from 30.0% to 64.2%. Several patients (12.1-42.7%) transfused with red blood cells were discharged with a hemoglobin concentration >7 mmol/l, indicating inappropriate transfusions. The relative risk of receiving an allogeneic blood transfusion was 2.1 (95% CI: 1.6-2.7) in the hospital with the highest transfusion rate, after adjustment for patient-, drug-, and procedure-related factors. Interesting differences in transfusion rates exists in Danish hospitals and these differences may reflect true variations in transfusion practices. Audits create a basis for educational efforts among surgeons and anesthesiologists to standardize transfusion practices.
Department of Cardiothoracic Surgery, Aalborg Hospital, Hobrovej, Postboks 365, DK-9100 Aalborg, Denmark. jan.jesper.andreasen@stofanet.dk
Jan J
JJ
Andreasen
Mikkel
M
Westen
Peter A
PA
Pallesen
Søren
S
Jensen
Anders
A
Gorst-Rasmussen
Søren P
SP
Johnsen
D000368:Aged; D000714:Anastomosis, Surgical / Q000706:statistics & numerical data; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D016913:Blood Component Transfusion / Q000592:standards / Q000706:statistics & numerical data*; D016063:Blood Loss, Surgical / Q000517:prevention & control* / Q000706:statistics & numerical data; D002315:Cardiopulmonary Bypass / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass / Q000592:standards / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000097:blood / Q000453:epidemiology / Q000601:surgery*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008485:Medical Audit / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors
D000933:Antifibrinolytic Agents; D006454:Hemoglobins; D010975:Platelet Aggregation Inhibitors