Center on Systems, Outcomes and Quality in Chronic Disease and Rehabilitation, Research Enhancement Award Program, Providence Veterans Affairs Medical Center, and Department of Community Health, Brown University, Providence, RI, USA.
Ann Surg. 2012 Apr;255(4):708-14. doi: 10.1097/SLA.0b013e31824a55b9.
Blood loss during surgery is an important operative complication in patients undergoing major noncardiac surgery and may increase postoperative morbidity and mortality. Variations in the delivery of operative blood transfusions to treat blood loss depend not only on the patient and surgery characteristics but also on the hospital transfusion practices, and may explain differences in the hospitals' postoperative outcomes. We determine the relationship between hospital-level rates of intraoperative blood transfusion and 30-day mortality among older patients with significant intraoperative blood loss.
Among 46,608 operative patients aged 65 years or older whose estimated blood loss was 500 mL or greater in 122 Veterans Affairs (VA) hospitals during years 1997 to 2004, we examined the relationship between hospital-level transfusion rates and adjusted 30-day postoperative mortality rates using linear regression modeling.
Hospital-level rates of intraoperative blood transfusion for older surgical patients with significant blood loss varied from 10% to 92%. Hospitals in the highest tertile for the rate of intraoperative transfusion had the highest number of patients with 500 mL or more surgical blood loss and lowest risk-adjusted 30-day surgical mortality. For every 10% increase in the rate of intraoperative blood transfusion, there was a 0.7% (95% CI: 0.3%-1.1%) decrease in the hospital's adjusted 30-day postoperative mortality for these high-risk patients.
Large variation exists in hospitals' intraoperative blood transfusion practices for older patients with significant surgical blood loss. Hospitals with higher transfusion rates for patients with significant surgical blood loss have lower adjusted 30-day mortality for these patients. Hospital intraoperative blood transfusion practices may be a promising surgical quality indicator.
术中失血是行非心脏大手术患者的一种重要手术并发症，可能增加术后发病率和死亡率。治疗失血而输注血液制品的实施情况不仅取决于患者和手术特点，还取决于医院的输血实践，并可能解释了医院术后结局的差异。我们确定了医院层面术中输血率与术中失血量大的老年患者 30 天死亡率之间的关系。
在 1997 年至 2004 年间，122 家退伍军人事务部（VA）医院中，46608 名年龄在 65 岁或以上、估计失血量为 500ml 或以上的手术患者中，我们使用线性回归模型检查了医院层面输血率与调整后的 30 天术后死亡率之间的关系。
术中输血率因术中失血量大的老年手术患者而异，从 10%到 92%不等。术中输血率最高的 tertile 医院中，有 500ml 或更多手术失血的患者数量最多，风险调整后 30 天手术死亡率最低。术中输血率每增加 10%，这些高危患者的医院调整后 30 天术后死亡率就会降低 0.7%（95%CI：0.3%-1.1%）。
术中输血治疗大量手术失血的老年患者的医院实践存在很大差异。对于术中失血量大的患者，输血率较高的医院，这些患者的调整后 30 天死亡率较低。医院术中输血实践可能是一个有前途的手术质量指标。
