title: Large Variation in Blood Transfusion Use After Colorectal Resection: A Call to Action.
abstract: BACKGROUND
  Perioperative blood transfusions are associated with an increased risk of adverse postoperative outcomes through immunomodulatory effects.
  
  
  OBJECTIVE
  The purpose of this study was to identify factors associated with variation in blood transfusion use after elective colorectal resection and associated postoperative infectious complications
  
  
  METHODS
  This was a retrospective cohort study.
  
  
  METHODS
  The study included elective colorectal resections in New York State from 2001 to 2013.
  
  
  METHODS
  The study cohort consists of 125,160 colorectal resections. Patients who were admitted nonelectively or who were admitted before the date of surgery were excluded.
  
  
  METHODS
  Receipt of a perioperative allogeneic red blood cell transfusion and the secondary end points of postoperative pneumonia, surgical site infection, intra-abdominal abscess, and sepsis were measured.
  
  
  RESULTS
  The overall rate of perioperative blood transfusion for the study cohort was 13.9%. The unadjusted blood transfusion rates ranged from 2.4% to 58.7% for individual surgeons and 2.9% to 32.8% for individual hospitals. After controlling for patient-, surgeon-, and hospital-level factors in a 3-level mixed-effects multivariable model, significant variation was still present across both surgeons (p < 0.0001) and hospitals (p < 0.0001), with a 16.8-fold difference in adjusted blood transfusion rates across surgeons and a 13.2-fold difference in adjusted blood transfusion rates across hospitals. Receipt of a blood transfusion was also independently associated with pneumonia (OR = 3.23 (95% CI, 2.92-3.57)), surgical site infection (OR = 2.27 (95% CI, 2.14-2.40)), intra-abdominal abscess (OR = 2.72 (95% CI, 2.41-3.07)), and sepsis (OR = 4.51 (95% CI, 4.11-4.94)).
  
  
  CONCLUSIONS
  Limitations include the retrospective design and the possibility of miscoding within administrative data.
  
  
  CONCLUSIONS
  Large surgeon- and hospital-level variations in perioperative blood transfusion use for patients undergoing colorectal resection are present despite controlling for patient-, surgeon-, and hospital-level factors. In addition, receipt of a blood transfusion was independently associated with an increased risk of postoperative infectious complications. These findings support the creation and implementation of perioperative blood transfusion protocols aimed at limiting unwarranted variation.
authors.affiliation: 1 Department of Surgery, Surgical Health Outcomes and Research Enterprise, University of Rochester Medical Center, Rochester, New York 2 Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Aquina
authors.forename: Neil
authors.initials: N
authors.lastname: Blumberg
authors.forename: Christian P
authors.initials: CP
authors.lastname: Probst
authors.forename: Adan Z
authors.initials: AZ
authors.lastname: Becerra
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Hensley
authors.forename: Katia
authors.initials: K
authors.lastname: Noyes
authors.forename: John R T
authors.initials: JR
authors.lastname: Monson
authors.forename: Fergal J
authors.initials: FJ
authors.lastname: Fleming
mesh_terms: D018784:Abdominal Abscess / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D017558:Elective Surgical Procedures; D017707:Erythrocyte Transfusion / Q000009:adverse effects* / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009518:New York; D011014:Pneumonia / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D057216:Propensity Score; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology