title: The proportion of variation in perioperative transfusion decisions in Canada attributable to the hospital.
abstract: OBJECTIVE
  Hospital variation in transfusion practices has been described previously but the proportion of variation attributable to the hospital has not. The objective of this report was to quantify hospital variation in red cell transfusion decisions perioperatively for patients undergoing coronary artery bypass surgery (CABG).
  
  
  METHODS
  We used a cross-sectional study design using pretested self-administered mailed questionnaires sent to all anesthesiologists and cardiac surgeons involved in CABG in Canada.
  
  
  RESULTS
  Responses were received from anesthesiologists from all 32 hospital sites and from cardiac surgeons from 30/32 sites (94%). There was variation attributable to the hospital in transfusion triggers selected (P<0.0001). For patients who had uncomplicated CABG surgery, the range of transfusion triggers among hospitals for the intraoperative and postoperative case scenarios were 61 to 80 gxL(-1) and 64 to 80 gxL(-1), respectively. The hospital accounted for 20% of the variation in the transfusion practice intraoperatively and postoperatively. The remainder of the variation was attributable to the individual physician. Academic affiliation and the number of surgical cases performed at the hospital were not significant factors impacting on the transfusion triggers selected
  
  
  CONCLUSIONS
  This is the first study to quantify the variation in red cell transfusion practices according to individual physicians and the hospital. The variation attributed to the hospital is significant. The explanation for the variation in transfusion decisions that relate to the hospital needs to be explored further in order to help optimize transfusion practice.
authors.affiliation: Division of Hematology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. shehatan@smh.toronto.on.ca
authors.forename: Nadine
authors.initials: N
authors.lastname: Shehata
authors.forename: Kumanan
authors.initials: K
authors.lastname: Wilson
authors.forename: C David
authors.initials: CD
authors.lastname: Mazer
authors.forename: George
authors.initials: G
authors.lastname: Tomlinson
authors.forename: David
authors.initials: D
authors.lastname: Streiner
authors.forename: Paul
authors.initials: P
authors.lastname: Hébert
authors.forename: Gary
authors.initials: G
authors.lastname: Naglie
mesh_terms: D001026:Coronary Artery Bypass; D003430:Cross-Sectional Studies; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D015999:Multivariate Analysis; D011795:Surveys and Questionnaires