Research Activities, July 2013
Odds of receiving a transfusion during major noncardiac surgery can vary fourfold among hospitals
Your chance of receiving a blood transfusion during major noncardiac surgery depends on the hospital in which you have your operation, according to a new study. While blood transfusion reduces risks associated with anemia, overuse of blood transfusions may pose serious health risks to patients having major surgery.
The researchers used a database of surgical procedures conducted at academic medical centers to look at transfusions in 77 hospitals for 54,405 patients undergoing primary total hip replacement (THR), 21,334 patients having primary colectomy, and 7,929 patients undergoing primary, pancreatic duodenectomy. Hospitals were characterized as being high-transfusion, average-transfusion, and low-transfusion.
Among the THR patients, 31 percent received perioperative red blood cell (RBC) transfusion, 0.9 percent received frozen fresh plasma (FFP) transfusion, and 0.5 percent received perioperative platelet transfusion. The hospital-specific transfusion rates for THR ranged from 1.5–77.8 percent for RBCs, 0–11.4 percent for FFP, and 0–6.3 percent for platelets. Comparable levels of variability occurred for each of the other major noncardiac surgeries studied.
When the researchers grouped the hospitals into high-, average-, or low-transfusion (separately for each type of surgery), patients undergoing THR had a 2.4 higher odds of receiving RBCs at a high-transfusion hospital than an average-transfusion hospital, but 55 percent lower odds of doing so at a low-transfusion hospital. Comparable differences were noted for the use of FFP and platelets during THR. Differences in transfusion rates among the hospitals were similar for colectomy and pancreaticduodenectomy. The findings were based on data from the University HealthSystem Consortium database for June 2006 through September 2010.
The study was funded in part by AHRQ (HS16737). More details are in "Variation in blood transfusion in patients undergoing major noncardiac surgery," by Feng Qian, M.D., Ph.D., Turner M. Osler, M.D., Michael P. Eaton, M.D., and others in the February 2013 Annals of Surgery 257(2), pp. 266–278.