title: Impact of institutional culture on rates of transfusions during cardiovascular procedures: The Michigan experience.
abstract: BACKGROUND
  Red blood cell (RBC) transfusions have been associated with morbidity and mortality in both coronary artery bypass grafting (CABG) and percutaneous coronary interventions (PCI). As a mechanism for identifying determinants of RBC practice, we quantified the relationship between a center's PCI and CABG transfusion rate.
  
  
  METHODS
  We identified all patients undergoing CABG (n = 16,568) or PCI (n = 94,634) at each of 33 centers from 2010 through 2012 in the state of Michigan and compared perioperative RBC transfusion rates for CABG and PCI at each center. Crude and adjusted transfusion rates were modeled separately. We adjusted for common preprocedural risk factors (12 for CABG and 23 for PCI) and reported Pearson correlation coefficients based on the crude and risk-adjusted rates.
  
  
  RESULTS
  As expected, RBC transfusion was more common after CABG (mean 46.5%) than PCI (mean 3.3%), with wide variation across centers for both (CABG min:max 26.5:71.3, PCI min:max 1.6:6.0). However, RBC transfusion rates were significantly correlated between CABG and PCI in both crude, 0.48 (P = .005), and adjusted, 0.53 (P = .001), analyses. These findings were consistent when restricting to nonemergent cases (radj = 0.44, P = .001).
  
  
  CONCLUSIONS
  Red blood cell transfusion rates were significantly correlated between the CABG and PCI at individual hospitals in Michigan, independent of patient case mix. Future work should explore institutional practice patterns, philosophies, and guidelines for RBC transfusions.
authors.affiliation: Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI. Electronic address: likosky@umich.edu.
authors.forename: Donald S
authors.initials: DS
authors.lastname: Likosky
authors.affiliation: Department of Biostatistics, University of Michigan, Ann Arbor, MI.
authors.forename: Min
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Department of Surgery, Division of Cardiac Surgery, Henry Ford Hospital, Detroit, MI.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Paone
authors.affiliation: St Mary's of Michigan Saginaw, Saginaw, MI.
authors.forename: John
authors.initials: J
authors.lastname: Collins
authors.affiliation: Department of Cardiothoracic Surgery, Bronson Methodist Hospital, Bronson, MI.
authors.forename: Alphonse
authors.initials: A
authors.lastname: DeLucia
authors.affiliation: Detroit Medical Center-Cardiovascular Institute, Detroit, MI.
authors.forename: Theodore
authors.initials: T
authors.lastname: Schreiber
authors.affiliation: Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Patty
authors.initials: P
authors.lastname: Theurer
authors.affiliation: Crittenton Hospital, Rochester, MI.
authors.forename: Samer
authors.initials: S
authors.lastname: Kazziha
authors.affiliation: Thoracic & Cardiovascular Institute, Sparrow Hospital, Lansing, MI.
authors.forename: Dale
authors.initials: D
authors.lastname: Leffler
authors.affiliation: Department of Cardiology, Bronson Methodist Hospital, Bronson, MI.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Wunderly
authors.affiliation: Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI.
authors.forename: Hitinder S
authors.initials: HS
authors.lastname: Gurm
authors.affiliation: Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Prager
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000601:surgery*; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D062645:Percutaneous Coronary Intervention; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends