Stonemetz Jerry L, Allen Paul X, Wasey Jack, Rivers Richard J, Ness Paul M, Frank Steven M
Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
Transfusion. 2014 Oct;54(10 Pt 2):2716-23. doi: 10.1111/trf.12548. Epub 2014 Feb 24.
Blood utilization has become an important outcome measure for surgical patients because of the recognized risks and costs associated with transfusion. However, comparisons of blood utilization between providers or institutions are difficult, because there is no standard method for risk adjustment when assessing surgical blood requirements. We examined whether accepted diagnosis-related group (DRG) case mix indexes can be used for this purpose.
We retrospectively analyzed electronic medical record data from 37,403 surgical inpatients to assess the relationship between intraoperative blood component transfusion requirements and the case mix indexes: weighted Medicare severity DRG and weighted all-patient refined DRG. Thirty-one surgeons from the general surgery service were compared to determine correlations between blood component utilization and case mix index in both a risk unadjusted and an adjusted fashion.
Case mix indexes and transfusion requirements were directly correlated for red blood cells (RBCs), plasma, and platelet (PLT) transfusions (p < 0.0001 for all three blood components, for both indexes). Surgeons with greater case mix index values had greater transfusion requirements, and adjustment for case mix index resulted in less variation among surgeons (p < 0.0001, p = 0.0003, and p < 0.0001 for unadjusted vs. adjusted utilization of RBCs, plasma, and PLTs, respectively).
The standard DRG-based case mix indexes used to determine hospital reimbursement were strongly correlated with intraoperative transfusion requirements. We propose that these methods can be used as a risk-adjusted blood utilization metric for surgical patients.
由于输血存在公认的风险和成本，血液利用已成为外科手术患者一项重要的结局指标。然而，比较不同医疗服务提供者或机构之间的血液利用情况很困难，因为在评估手术用血需求时没有标准的风险调整方法。我们研究了公认的诊断相关分组（DRG）病例组合指数是否可用于此目的。
我们回顾性分析了37403例外科住院患者的电子病历数据，以评估术中血液成分输血需求与病例组合指数之间的关系：加权医疗保险严重度DRG和加权全患者精细DRG。对普通外科的31名外科医生进行比较，以确定在未调整风险和调整风险的情况下血液成分利用与病例组合指数之间的相关性。
病例组合指数与红细胞（RBC）、血浆和血小板（PLT）输血的需求直接相关（两种指数下，所有三种血液成分的p均<0.0001）。病例组合指数值较高的外科医生输血需求更大，对病例组合指数进行调整后，外科医生之间的差异较小（红细胞、血浆和血小板未调整与调整后的利用率相比，p分别为<0.0001、0.0003和<0.0001）。
用于确定医院报销的基于DRG的标准病例组合指数与术中输血需求密切相关。我们建议这些方法可作为外科手术患者风险调整后的血液利用指标。
