Division of Cardiology Alpert Medical School of Brown University Providence RI.
Division of Cardiology Massachusetts General Hospital and Harvard Medical School Boston MA.
J Am Heart Assoc. 2020 Nov 17;9(22):e016232. doi: 10.1161/JAHA.119.016232. Epub 2020 Nov 3.
Background The relationship between local hospital culture and transfusion rates following endovascular and surgical cardiovascular procedures has not been well studied. Methods and Results Patients undergoing coronary revascularization, aortic valve replacement, lower extremity peripheral vascular intervention, or carotid artery revascularization from up to 852 US hospitals in the Nationwide Readmissions Database were identified. Crude and risk-standardized red blood cell transfusion rates were determined for each procedure. Pearson correlation coefficients were calculated between respective procedural transfusion rates. Median odds ratios were estimated to reflect between-hospital variability in red blood cell transfusion rates following the same procedure for a given patient. There was wide variation in red blood cell transfusion rates across different procedures, from 2% following carotid endarterectomy to 29% following surgical aortic valve replacement. For surgical and endovascular modalities, transfusion rates at the same hospital were highly correlated for aortic valve replacement (=0.67; <0.001), moderately correlated for coronary revascularization (=0.56; <0.001) and peripheral vascular intervention (=0.51; <0.001), and weakly correlated for carotid artery revascularization (=0.19, <0.001). Median odds ratios were all >2, highest for coronary artery bypass graft surgery and surgical aortic valve replacement, indicating substantial site variation in transfusion rates. Conclusions After adjustment for patient-related factors, wide variation in red blood cell transfusion rates remained across surgical and endovascular procedures employed for the same cardiovascular condition. Transfusion rates following these procedures are highly correlated at individual hospitals and vary widely across hospitals. In aggregate, these findings suggest that local institutional culture significantly influences the decision to transfuse following invasive cardiovascular procedures and highlight the need for randomized data to inform such decisions.
血管内和心血管手术治疗后，局部医院文化与输血率之间的关系尚未得到充分研究。
从全美再入院数据库中确定了多达 852 家美国医院进行的冠状动脉血运重建术、主动脉瓣置换术、下肢外周血管介入术或颈动脉血运重建术的患者。确定了每种手术的原始和风险标准化红细胞输血率。计算了各自手术输血率之间的皮尔逊相关系数。中位数优势比用于反映给定患者接受相同手术时红细胞输血率的医院间差异。不同手术的红细胞输血率差异很大，从颈动脉内膜切除术的 2%到主动脉瓣置换术的 29%。对于手术和血管内治疗方式，同一医院的输血率与主动脉瓣置换术高度相关（=0.67；<0.001），与冠状动脉血运重建术（=0.56；<0.001）和外周血管介入术（=0.51；<0.001）中度相关，与颈动脉血运重建术相关性较弱（=0.19，<0.001）。中位数优势比均>2，以冠状动脉旁路移植术和主动脉瓣置换术最高，表明输血率存在大量部位差异。
在调整了患者相关因素后，对于相同心血管疾病采用的手术和血管内治疗方式，红细胞输血率仍存在广泛差异。这些手术的输血率在各个医院高度相关，在医院之间差异很大。总的来说，这些发现表明，局部机构文化显著影响了侵袭性心血管手术后输血的决策，并强调需要随机数据来为这些决策提供信息。
