Maddux Franklin W, Dickinson Timothy A, Rilla Dirck, Kamienski Robert W, Saha Sibu P, Eales Frazier, Rego Alfredo, Donias Harry W, Crutchfield Susan L, Hardin Robert A
Specialty Care Services Group, Nashville, Tennessee 37203, USA.
Am J Med Qual. 2009 Sep-Oct;24(5):403-11. doi: 10.1177/1062860609339384. Epub 2009 Jul 17.
The variability in frequency of allogeneic blood transfusion during coronary artery bypass surgery (CABG) is a concern. Evidence-based guidelines support minimizing the use of blood during open heart surgery. The Hospital Clinical Services Group quality indicator database was queried for intraoperative red blood cell (RBC) transfusions in 17 252 isolated CABG surgery cases during 2007. Institutional variability was observed in the frequency of intraoperative RBC transfusion rates, which ranged from 0% to 85.7%. The institution mean RBC transfusion rate was 40.8%. Regional geographic and cardiac program size variations were observed in RBC transfusion rates and volume with significant variation. Notable institutional variability persists with respect to intraoperative RBC transfusion in isolated CABG surgery despite clear evidence and guidelines to support techniques to minimize RBC transfusion. Such results support the hypothesis that incorporating evidence-based transfusion-related practices in open heart surgery are not uniformly adopted.
冠状动脉搭桥手术（CABG）期间异体输血频率的变异性令人担忧。循证指南支持在心脏直视手术中尽量减少血液使用。查询了医院临床服务组质量指标数据库，以获取2007年期间17252例单纯CABG手术病例的术中红细胞（RBC）输血情况。术中RBC输血率存在机构变异性，范围从0%至85.7%。机构平均RBC输血率为40.8%。在RBC输血率和输血量方面观察到区域地理和心脏项目规模差异显著。尽管有明确证据和指南支持采用尽量减少RBC输血的技术，但单纯CABG手术术中RBC输血仍存在显著的机构变异性。这些结果支持这样一种假设，即心脏直视手术中纳入循证输血相关做法并未得到统一采用。
