Variation of blood transfusion in patients undergoing major noncardiac surgery.
OBJECTIVE
To examine the hospital variability in use of red blood cells (RBCs), fresh-frozen plasma (FFP), and platelet transfusions in patients undergoing major noncardiac surgery.


BACKGROUND
Blood transfusion is commonly used in surgical procedures in the United States. Little is known about the hospital variability in perioperative transfusion rates for noncardiac surgery.


METHODS
We used the University HealthSystem Consortium database (2006-2010) to examine hospital variability in use of allogeneic RBC, FFP, and platelet transfusions in patients undergoing major noncardiac surgery. We used regression-based techniques to quantify the variability in hospital transfusion practices and to study the association between hospital characteristics and the likelihood of transfusion.


RESULTS
After adjusting for patient risk factors, hospital transfusion rates varied widely for patients undergoing total hip replacement (THR), colectomy, and pancreaticoduodenectomy. Compared with patients undergoing THR in average-transfusion hospitals, patients treated in high-transfusion hospitals have a greater than twofold higher odds of being transfused with RBCs [adjusted odds ratio (AOR) = 2.41; 95% confidence interval (CI), 1.89-3.09], FFP (AOR = 2.81; 95% CI, 2.02-3.91), and platelets (AOR = 2.52; 95% CI, 1.95-3.25), whereas patients in low-transfusion hospitals have an approximately 50% lower odds of receiving RBCs (AOR = 0.45; 95% CI, 0.35-0.57), FFP (AOR = 0.37; 95% CI, 0.27-0.51), and platelets (AOR = 0.42; 95% CI, 0.29-0.62). Similar results were obtained for colectomy and pancreaticoduodenectomy.


CONCLUSIONS
There was dramatic hospital variability in perioperative transfusion rates among patients undergoing major noncardiac surgery at academic medical centers. In light of the potential complications of transfusion therapy, reducing this variability in hospital transfusion practices may result in improved surgical outcomes.
Department of Anesthesiology, University of Rochester School of Medicine, Rochester, NY 14642, USA. Feng_Qian@urmc.rochester.edu
Feng
F
Qian
Turner M
TM
Osler
Michael P
MP
Eaton
Andrew W
AW
Dick
Samuel F
SF
Hohmann
Stewart J
SJ
Lustik
Carol A
CA
Diachun
Robert
R
Pasternak
Richard N
RN
Wissler
Laurent G
LG
Glance
D000046:Academic Medical Centers / Q000706:statistics & numerical data; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D003082:Colectomy / Q000706:statistics & numerical data*; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006788:Hospitals, Voluntary / Q000706:statistics & numerical data; D006801:Humans; D016577:Pancreaticoduodenectomy / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care