title: Variation in intraoperative and postoperative red blood cell transfusion in pediatric surgery.
abstract: BACKGROUND
  Intraoperative and postoperative red blood cell (RBC) transfusions are relatively frequent events tracked in the American College of Surgeons' National Surgical Quality Improvement Program-Pediatric (ACS-NSQIP-P). This study sought to quantify variation in RBC transfusion practices among hospitals.
  
  
  METHODS
  This is an observational study of children older than 28 days who underwent a general, neurologic, urologic, otolaryngologic, plastic, or orthopedic operation at 50 hospitals in participating in the ACS-NSQIP-P during 2011 to 2012. The primary outcome was whether or not a RBC transfusion was administered from incision time to 72 hours postoperatively. Transfusions of fresh-frozen plasma, cryoprecipitate, and platelets were excluded from data abstraction due the rarity of their administration. A multivariate hierarchical risk-adjustment model estimated the risk-adjusted hospital RBC transfusion odds ratio (OR) and designated hospitals by transfusion practice.
  
  
  RESULTS
  The mean RBC transfusion rate was 1.5%. Five preoperative variables were associated with greater than threefold increased odds of having an intraoperative or postoperative RBC transfusion; young age; 29 days to 1 year (OR, 5.9; p < 0.001) and 1 to 2 years (OR, 3.4; p < 0.001); American Society of Anesthesiologists Class IV (OR, 3.2; p < 0.001); procedure linear risk (OR, 3.1; p < 0.001); preoperative septic shock (OR, 14.5; p < 0.001); and preoperative cardiopulmonary resuscitation (OR, 8.1; p < 0.001). Twenty-five hospitals had RBC transfusion practices significantly different than risk-adjusted mean (17 higher and eight lower).
  
  
  CONCLUSIONS
  Intraoperative and postoperative RBC transfusion practices vary widely among hospitals after controlling for patient and procedural characteristics.
authors.affiliation: Icahn School of Medicine at Mount Sinai Medical Center, New York, New York.|David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Stey
authors.affiliation: Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical College, Wilmington, Delaware.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Vinocur
authors.affiliation: Nationwide Children's Hospital, the Ohio State University, Columbus, Ohio.
authors.forename: R Lawrence
authors.initials: RL
authors.lastname: Moss
authors.affiliation: Department of Surgery, Olin Business School, and Center for Health Policy, Washington University School of Medicine in St Louis, St Louis VA Medical Center, and BJC Healthcare, St Louis, Missouri.|American College of Surgeons, Chicago, Illinois.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Hall
authors.affiliation: American College of Surgeons, Chicago, Illinois.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Cohen
authors.affiliation: American College of Surgeons, Chicago, Illinois.
authors.forename: Kari
authors.initials: K
authors.lastname: Kraemer
authors.affiliation: David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.|American College of Surgeons, Chicago, Illinois.
authors.forename: Clifford Y
authors.initials: CY
authors.lastname: Ko
authors.affiliation: Nationwide Children's Hospital, the Ohio State University, Columbus, Ohio.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Kenney
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017707:Erythrocyte Transfusion / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016017:Odds Ratio; D011184:Postoperative Period; D012307:Risk Factors