title: National trends and variability in blood utilization in paediatric cardiac surgery.
abstract: Red blood cell transfusion is a common practice in paediatric cardiac surgery. Transfusion of red blood cells has been shown to be associated with an increase in morbidity in paediatric patients undergoing cardiac surgery. There is a huge variability in the practice of blood utilization within and across different practices. The aim of this study was to demonstrate the current variability and the trends over the past decade in blood usage among children's hospitals performing paediatric cardiac surgery.
  
  
  
  We performed a retrospective observational cohort study using the Paediatric Health Information System database from 43 participating paediatric hospitals in the USA. All discharge billing information for patients younger than 19 years of age who underwent cardiac surgery using cardiopulmonary bypass between 2005 and 2015 was investigated. Ten index diagnoses and procedures were investigated and analysed, based on age differences and on the Society of Thoracic Surgeon & European Association for Cardio-Thoracic Surgery mortality scores. Our main outcome variable was the unit(s) of homologous red blood cells charged for the first 24 h of admission for cardiac surgery.
  
  
  
  There was significant variability in red blood cell usage for a given diagnosis and procedural code across all the centres despite varied age ranges and complexity scores for the current and the last decade of paediatric cardiac surgical patients.
  
  
  
  We found a discernible variability in the current practice of blood utilization for a given procedure despite variability in the age and complexity of patients, with no changes in practice patterns for the last decade of paediatric cardiac surgery.
authors.affiliation: Department of Surgery, Pediatric Cardiothoracic Surgery, Northeast Pediatric Specialties (NEPS), Yale University School of Medicine, New Haven, CT, USA.|School of Medicine, University of Connecticut, Connecticut Children's Medical Center, Hartford, CT, USA.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Karimi
authors.affiliation: School of Medicine, University of Connecticut, Connecticut Children's Medical Center, Hartford, CT, USA.
authors.forename: Jill M
authors.initials: JM
authors.lastname: Sullivan
authors.affiliation: Department of Biostatistics, Connecticut Children's Medical Center, Hartford, CT, USA.
authors.forename: Trudy
authors.initials: T
authors.lastname: Lerer
authors.affiliation: Children's Hospital Association, Kansas City, MO, USA.
authors.forename: Carla
authors.initials: C
authors.lastname: Hronek
mesh_terms: D000293:Adolescent; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012042:Registries; D012189:Retrospective Studies
keywords: Blood utilization; Cardiac surgery; Congenital heart disease