Irving Adam, Harris Anthony, Petrie Dennis, Avdic Daniel, Smith Julian, Tran Lavinia, Reid Christopher M, McQuilten Zoe K
Centre for Health Economics, Monash Business School, Monash University, Melbourne, Victoria, Australia.
Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Vox Sang. 2025 Jan;120(1):47-54. doi: 10.1111/vox.13751. Epub 2024 Oct 14.
Previously published studies have consistently identified significant variation in red blood cell (RBC) transfusions during cardiac surgery. Clinical guidelines can be effective at improving the average quality of care; however, their impact on variation in practice is rarely studied. Herein, we estimated how variation in RBC use across cardiac surgeons changed after the publication of national patient blood management guidelines.
We performed a pre-post study estimating change in variation in RBC transfusions across 80 cardiac surgeons in 29 hospitals using a national cardiac surgery registry. Variation across surgeons was estimated using fixed-effects regressions controlling for surgery and patient characteristics and an empirical Bayes shrinkage to adjust for sampling error. RBC use was measured by three metrics-the total number of units transfused, the proportion of patients transfused and the number of units transfused, conditional on receiving RBC.
The primary analysis utilized 35,761 elective cardiac surgeries performed between March 2009 and February 2015 and identified a 24.5% reduction (p < 0.0001) in mean total units transfused accompanied by a 37.2% reduction (p = 0.040) in the variation across surgeons. The reduction in mean total units was driven by both the proportion of patients transfused and the number of units transfused, conditional on receiving RBC, while the reduction in variation was only driven by the latter.
In our study of RBC transfusions across cardiac surgeons, the surgeons who used more RBC in the pre-guideline period experienced larger reductions in RBC use after the guidelines were published.
先前发表的研究一致发现心脏手术期间红细胞（RBC）输注存在显著差异。临床指南可有效提高护理的平均质量；然而，其对实践差异的影响鲜有研究。在此，我们评估了国家患者血液管理指南发布后，心脏外科医生之间红细胞使用差异的变化情况。
我们进行了一项前后对照研究，利用国家心脏手术登记处的数据，评估了29家医院80名心脏外科医生红细胞输注差异的变化。通过控制手术和患者特征的固定效应回归以及用于调整抽样误差的经验贝叶斯收缩法来估计外科医生之间的差异。红细胞使用情况通过三个指标衡量：输注的单位总数、接受输血的患者比例以及接受红细胞输血时输注的单位数。
主要分析使用了2009年3月至2015年2月期间进行的35761例择期心脏手术，结果显示平均输注单位总数减少了24.5%（p < 0.0001），同时外科医生之间的差异减少了37.2%（p = 0.040）。平均输注单位总数的减少是由接受输血的患者比例和接受红细胞输血时输注的单位数共同驱动的，而差异的减少仅由后者驱动。
在我们对心脏外科医生红细胞输注的研究中，在指南发布前使用更多红细胞的外科医生在指南发布后红细胞使用量减少幅度更大。
