title: Impact of surgeon experience on the rate of blood transfusion in off-pump coronary artery bypass.
abstract: OBJECTIVE
  Off-pump coronary artery bypass (OPCAB) reduces the rate of blood transfusion. No studies have focused on the effect of surgeon experience on the transfusion rate. We sought to assess the transfusion rate in OPCAB and to evaluate the effect of surgeon experience.
  
  
  METHODS
  Retrospective review of 1055 consecutive patients undergoing OPCAB between 2000 and 2012. Patients were divided into tripartites by the year of operation (2000-2004, 2005-2008, and 2009-2012). Surgeon experience was evaluated with revascularization index and conversion rate.
  
  
  RESULTS
  Mode of intervention was elective in 768, urgency in 185, and emergency in 102 patients (10%). Blood transfusion was associated with increased rates of hospital mortality and sternal wound/bloodstream infections. Revascularization index was 1.22 ± 0.29 per patient and increased over time, from 1.05 ± 0.21 in 2000-2004 to 1.39 ± 0.26 in 2009-2012. Conversion rate was 10% and decreased over time, from 17% in 2000-2004 to 6% in 2009-2012. The average rate of blood transfusion was 58% and decreased over time, from 74% in 2000-2004 to 41% in 2009-2012. Rate of red blood cell transfusion was 56% and decreased from 72% in 2000-2004 to 40% in 2009-2012. Rate of platelet transfusion was 21% and decreased from 25% in 2000-2004 to 15% in 2009-2012.The most significant decrease in the transfusion rate was observed in nonemergency cases.
  
  
  CONCLUSIONS
  Surgeon experience reduced the need of blood transfusion after OPCAB. Increasing surgeon experience was associated with a 33% reduction in blood transfusion rate.
authors.affiliation: Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan, ROC; Graduate Institute of Clinic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan, ROC.
authors.forename: Jeng-Wei
authors.initials: JW
authors.lastname: Chen
authors.affiliation: Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, ROC. Electronic address: ronbin@ntuh.gov.tw.
authors.forename: Ron-Bin
authors.initials: RB
authors.lastname: Hsu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D047549:Coronary Artery Bypass, Off-Pump; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011361:Professional Competence; D012189:Retrospective Studies; D066231:Surgeons / Q000592:standards*; D013624:Taiwan
keywords: blood transfusion; off-pump coronary artery bypass; surgeon experience