title: Variation in Red Blood Cell Transfusion Practices During Cardiac Operations Among Centers in Maryland: Results From a State Quality-Improvement Collaborative.
abstract: BACKGROUND
  Variation in red blood cell (RBC) transfusion practices exists at cardiac surgery centers across the nation. We tested the hypothesis that significant variation in RBC transfusion practices between centers in our state's cardiac surgery quality collaborative remains even after risk adjustment.
  
  
  METHODS
  Using a multiinstitutional statewide database created by the Maryland Cardiac Surgery Quality Initiative (MCSQI), we included patient-level data from 8,141 patients undergoing isolated coronary artery bypass (CAB) or aortic valve replacement at 1 of 10 centers. Risk-adjusted multivariable logistic regression models were constructed to predict the need for any intraoperative RBC transfusion, as well as for any postoperative RBC transfusion, with anonymized center number included as a factor variable.
  
  
  RESULTS
  Unadjusted intraoperative RBC transfusion probabilities at the 10 centers ranged from 13% to 60%; postoperative RBC transfusion probabilities ranged from 16% to 41%. After risk adjustment with demographic, comorbidity, and operative data, significant intercenter variability was documented (intraoperative probability range, 4% -59%; postoperative probability range, 13%-39%). When stratifying patients by preoperative hematocrit quartiles, significant variability in intraoperative transfusion probability was seen among all quartiles (lowest quartile: mean hematocrit value, 30.5% ± 4.1%, probability range, 17%-89%; highest quartile: mean hematocrit value, 44.8% ± 2.5%; probability range, 1%-35%).
  
  
  CONCLUSIONS
  Significant variation in intercenter RBC transfusion practices exists for both intraoperative and postoperative transfusions, even after risk adjustment, among our state's centers. Variability in intraoperative RBC transfusion persisted across quartiles of preoperative hematocrit values.
authors.affiliation: Division of Cardiac Surgery, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: J Trent
authors.initials: JT
authors.lastname: Magruder
authors.affiliation: Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Elena
authors.initials: E
authors.lastname: Blasco-Colmenares
authors.affiliation: Division of Cardiac Surgery, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Todd
authors.initials: T
authors.lastname: Crawford
authors.affiliation: Division of Cardiac Surgery, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Diane
authors.initials: D
authors.lastname: Alejo
authors.affiliation: Division of Cardiac Surgery, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: John V
authors.initials: JV
authors.lastname: Conte
authors.affiliation: Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Rawn
authors.initials: R
authors.lastname: Salenger
authors.affiliation: Maryland Cardiac Surgery Quality Initiative, Baltimore, Maryland.
authors.forename: Clifford E
authors.initials: CE
authors.lastname: Fonner
authors.affiliation: Beverly & Jerome Fine Cardiac Valve Center, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Kwon
authors.affiliation: Department of Cardiac Surgery, Washington Adventist Hospital, Takoma Park, Maryland.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bobbitt
authors.affiliation: Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: James M
authors.initials: JM
authors.lastname: Brown
authors.affiliation: The Heart Institute, Western Maryland Health System, Cumberland, Maryland.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Nelson
authors.affiliation: Cardiothoracic Surgery Research Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
authors.forename: Keith A
authors.initials: KA
authors.lastname: Horvath
authors.affiliation: Division of Cardiac Surgery, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: gwhitman@jhmi.edu.
authors.forename: Glenn R
authors.initials: GR
authors.lastname: Whitman
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control* / Q000706:statistics & numerical data; D006348:Cardiac Surgical Procedures; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008396:Maryland; D008875:Middle Aged; D011184:Postoperative Period; D058996:Quality Improvement; D012189:Retrospective Studies