title: Benchmarking the use of blood products in cardiac surgery to stimulate awareness of transfusion behaviour : Results from a four-year longitudinal study.
abstract: BACKGROUND
  Cardiac operations account for a large proportion of the blood transfusions given each year, leading to high costs and an increased risk to patient safety. Therefore, it is important to explore initiatives to reduce transfusion rates. This study aims to provide a benchmark for transfusion practice by inter-hospital comparison of transfusion rates, blood product use and costs related to patients undergoing coronary artery bypass grafting (CABG), valve surgery or combined CABG and valve surgery.
  
  
  METHODS
  Between 2010 and 2013, patients from four Dutch hospitals undergoing CABG, valve surgery or combined CABG and valve surgery (n = 11,150) were included by means of a retrospective longitudinal study design.
  
  
  RESULTS
  In CABG surgery the transfusion rate ranged between 43 and 54%, in valve surgery between 54 and 67%, and in combined CABG and valve surgery between 80 and 88%. With the exception of one hospital, the trend in transfusion rate showed a significant decrease over time for all procedures. Hospitals differed significantly in the units of blood products given to each patient, and in the use of specific transfused combinations of blood products, such as red blood cells (RBCs) and a combination of RBCs, fresh frozen plasma (FFP) and platelets.
  
  
  CONCLUSIONS
  This study indicates that benchmarking blood product usage stimulates awareness of transfusion behaviour, which may lead to better patient safety and lower costs. Further studies are warranted to improve awareness of transfusion behaviour and increase the standardisation of transfusion practice in cardiac surgery.
authors.affiliation: EMGO+ Institute for Health and Care Research, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands. c.brouwers@vumc.nl.
authors.forename: C
authors.initials: C
authors.lastname: Brouwers
authors.affiliation: EMGO+ Institute for Health and Care Research, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Hooftman
authors.affiliation: EMGO+ Institute for Health and Care Research, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Vonk
authors.affiliation: Department of Cardiothoracic Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Vonk
authors.affiliation: Department of Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Stooker
authors.affiliation: Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: W H
authors.initials: WH
authors.lastname: Te Gussinklo
authors.affiliation: Department of Anesthesiology and Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: R M
authors.initials: RM
authors.lastname: Wesselink
authors.affiliation: EMGO+ Institute for Health and Care Research, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands.|Netherlands institute for health services research (NIVEL), Utrecht, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Wagner
authors.affiliation: EMGO+ Institute for Health and Care Research, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: M C
authors.initials: MC
authors.lastname: de Bruijne
keywords: Benchmark; Blood products; Blood transfusion; CABG; Cardiac surgery; Valve