title: Association between hospital intraoperative blood transfusion practices for surgical blood loss and hospital surgical mortality rates.
abstract: OBJECTIVE
  Blood loss during surgery is an important operative complication in patients undergoing major noncardiac surgery and may increase postoperative morbidity and mortality. Variations in the delivery of operative blood transfusions to treat blood loss depend not only on the patient and surgery characteristics but also on the hospital transfusion practices, and may explain differences in the hospitals' postoperative outcomes. We determine the relationship between hospital-level rates of intraoperative blood transfusion and 30-day mortality among older patients with significant intraoperative blood loss.
  
  
  METHODS
  Among 46,608 operative patients aged 65 years or older whose estimated blood loss was 500 mL or greater in 122 Veterans Affairs (VA) hospitals during years 1997 to 2004, we examined the relationship between hospital-level transfusion rates and adjusted 30-day postoperative mortality rates using linear regression modeling.
  
  
  RESULTS
  Hospital-level rates of intraoperative blood transfusion for older surgical patients with significant blood loss varied from 10% to 92%. Hospitals in the highest tertile for the rate of intraoperative transfusion had the highest number of patients with 500 mL or more surgical blood loss and lowest risk-adjusted 30-day surgical mortality. For every 10% increase in the rate of intraoperative blood transfusion, there was a 0.7% (95% CI: 0.3%-1.1%) decrease in the hospital's adjusted 30-day postoperative mortality for these high-risk patients.
  
  
  CONCLUSIONS
  Large variation exists in hospitals' intraoperative blood transfusion practices for older patients with significant surgical blood loss. Hospitals with higher transfusion rates for patients with significant surgical blood loss have lower adjusted 30-day mortality for these patients. Hospital intraoperative blood transfusion practices may be a promising surgical quality indicator.
authors.affiliation: Center on Systems, Outcomes and Quality in Chronic Disease and Rehabilitation, Research Enhancement Award Program, Providence Veterans Affairs Medical Center, and Department of Community Health, Brown University, Providence, RI, USA. Wen-Chih.Wu@va.gov
authors.forename: Wen-Chih
authors.initials: WC
authors.lastname: Wu
authors.forename: Amal
authors.initials: A
authors.lastname: Trivedi
authors.forename: Peter D
authors.initials: PD
authors.lastname: Friedmann
authors.forename: William G
authors.initials: WG
authors.lastname: Henderson
authors.forename: Tracy S
authors.initials: TS
authors.lastname: Smith
authors.forename: Roy M
authors.initials: RM
authors.lastname: Poses
authors.forename: Georgette
authors.initials: G
authors.lastname: Uttley
authors.forename: Michael
authors.initials: M
authors.lastname: Vezeridis
authors.forename: Charles B
authors.initials: CB
authors.lastname: Eaton
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D001803:Blood Transfusion / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006787:Hospitals, Veterans / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D008297:Male; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D020379:Risk Adjustment; D013514:Surgical Procedures, Operative / Q000401:mortality* / Q000592:standards; D014481:United States