Audet A M, Andrzejewski C, Popovsky M A
MassPRO, Waltham, MA 02154-1231, USA.
Orthopedics. 1998 Aug;21(8):851-8. doi: 10.3928/0147-7447-19980801-08.
This retrospective review analyzed and compared transfusion practices in patients undergoing orthopedic surgery in five Massachusetts hospitals with current practice guidelines; opportunities for improvement were identified. Patient-specific clinical information and data about transfusion practices were obtained from the medical records of 384 Medicare patients undergoing orthopedic surgery between January 1992 and December 1993. The number of patients who donated autologous blood preoperatively differed significantly among hospitals as did the number of autologous units that were unused. The number of blood units transfused at each transfusion event also differed significantly; some surgeons transfused > or =2 units in the majority of their patients, while others transfused 1 unit at a time. This variation in practice was not explained by differences in patients' clinical status. The mean pretransfusion hematocrit was higher for autologous versus allogeneic blood, suggesting more liberal criteria to transfuse autologous blood. Nearly half of all transfusion events were determined to have been potentially avoidable. Avoidable transfusions were also three to seven times more likely with autologous than with allogeneic blood. Significant inter-hospital differences existed in the number of elective surgery patients exposed to allogeneic blood. The major determinant of allogeneic blood use in these patients was the availability of autologous blood. Each additional autologous blood unit available decreased the odds of allogeneic blood exposure twofold. Differences in intraoperative and postoperative blood salvage use also were noted. These findings indicate that significant variations in practice exist. Comparative data enabled hospitals to identify and target specific areas for improvement.
这项回顾性研究分析并比较了马萨诸塞州五家医院接受骨科手术患者的输血实践与当前实践指南；确定了改进机会。从1992年1月至1993年12月期间接受骨科手术的384名医疗保险患者的病历中获取了患者特定的临床信息和输血实践数据。术前自体献血的患者数量在不同医院之间存在显著差异，未使用的自体血单位数量也存在显著差异。每次输血事件中输注的血液单位数量也存在显著差异；一些外科医生在大多数患者中输注≥2个单位，而另一些医生每次输注1个单位。这种实践差异无法用患者临床状况的差异来解释。自体血与异体血相比，输血前平均血细胞比容更高，这表明输注自体血的标准更为宽松。几乎一半的输血事件被确定为可能是可避免的。自体血的可避免输血可能性也是异体血的三到七倍。接受异体血的择期手术患者数量在不同医院之间存在显著差异。这些患者使用异体血的主要决定因素是自体血的可用性。每增加一个可用的自体血单位，异体血暴露的几率就会降低两倍。术中及术后血液回收利用的差异也被注意到。这些发现表明实践中存在显著差异。比较数据使医院能够识别并针对具体的改进领域。
