College of Health Professions, Medical University of South Carolina, Charleston, SC.
College of Health Professions, Medical University of South Carolina, Charleston, SC.
J Thorac Cardiovasc Surg. 2022 Mar;163(3):1015-1024.e1. doi: 10.1016/j.jtcvs.2020.04.141. Epub 2020 May 13.
To identify to what extent distinguishing patient and procedural characteristics can explain center-level transfusion variation during coronary artery bypass grafting surgery.
Observational cohort study using the Perfusion Measures and Outcomes Registry from 43 adult cardiac surgical programs from July 1, 2011, to July 1, 2017. Iterative multilevel logistic regression models were constructed using patient demographic characteristics, preoperative risk factors, and intraoperative conservation strategies to progressively explain center-level transfusion variation.
Of the 22,272 adult patients undergoing isolated coronary artery bypass surgery using cardiopulmonary bypass, 7241 (32.5%) received at least 1 U allogeneic red blood cells (range, 10.9%-59.9%). When compared with patients who were not transfused, patients who received at least 1 U red blood cells were older (68 vs 64 years; P < .001), were women (41.5% vs 15.9%; P < .001), and had a lower body surface area (1.93 m vs 2.07 m; P < .001), respectively. Among the models explaining center-level transfusion variability, the intraclass correlation coefficients were 0.07 for model 1 (random intercepts), 0.12 for model 2 (patient factors), 0.14 for model 3 (intraoperative factors), and 0.11 for model 4 (combined). The coefficient of variation for center-level transfusion rates were 0.31, 0.29, 0.40, and 0.30 for models 1 through 4, respectively. The majority of center-level variation could not be explained through models containing both patient and intraoperative factors.
The results suggest that variation in center-level red blood cells transfusion cannot be explained by patient and procedural factors alone. Investigating organizational culture and programmatic infrastructure may be necessary to better understand variation in transfusion practices.
确定区分患者和手术过程特征在多大程度上可以解释冠状动脉旁路移植术中中心水平输血的变化。
这是一项使用 2011 年 7 月 1 日至 2017 年 7 月 1 日来自 43 个成人心脏手术项目的灌注测量和结果登记处的观察性队列研究。使用患者人口统计学特征、术前危险因素和术中保护策略构建迭代多水平逻辑回归模型，以逐步解释中心水平输血变化。
在接受体外循环的 22272 例单独冠状动脉旁路手术的成年患者中，7241 例（32.5%）接受了至少 1 单位同种异体红细胞（范围为 10.9%-59.9%）。与未输血的患者相比，接受至少 1 单位红细胞的患者年龄更大（68 岁 vs 64 岁；P<0.001），为女性（41.5% vs 15.9%；P<0.001），体表面积更小（1.93m vs 2.07m；P<0.001）。在解释中心水平输血变异性的模型中，模型 1（随机截距）的组内相关系数为 0.07，模型 2（患者因素）为 0.12，模型 3（术中因素）为 0.14，模型 4（综合）为 0.11。模型 1 至 4 中心输血率的变异系数分别为 0.31、0.29、0.40 和 0.30。大多数中心水平的变异性无法通过包含患者和术中因素的模型来解释。
结果表明，中心水平红细胞输血的变化不能仅通过患者和手术过程因素来解释。可能需要调查组织文化和项目基础设施，以更好地了解输血实践的变异性。
