The specific hospital significantly affects red cell and component transfusion practice in coronary artery bypass graft surgery: A study of five hospitals

D. M. Surgenor, W. H. Churchill, E. L. Wallace, R. J. Rizzo, S. McGurk, L. T. Goodnough, K. J. Kao, T. A W Koerner, John D Olson, R. D. Woodson

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

BACKGROUND: Interhospital differences in blood transfusion practice during coronary artery bypass graft (CABG) surgery have been noted, but the underlying issues have not been identified. STUDY DESIGN AND METHODS: Records of 3217 consecutive CABG cases in five university teaching hospitals in 1992 and 1993 were stratified by hospital, type of revascularization conduit, patients sex, and other factors. Statistical methods were used to compare patient characteristics, transfusion outcomes, and hospital outcomes. RESULTS: Forward two-step logistic regression using patient likelihood of red cell transfusion factors in the first step and the specific hospital in the second step revealed a significant effect of hospital on the Δ odds ratios for red cell transfusion. This finding was confirmed by analyses of a highly stratified subset of cases, males in diagnosis-related group 107 (primary cases of coronary bypass without coronary catheterization) who underwent revascularization with venous and internal mammary artery grafts, revealing variations among hospitals from 109 to 457 units of red cells transfused per hundred cases. Corresponding variations in transfusions of all blood components were from 324 to 1019 units by hospital. Variation in red cell transfusion practice among surgeons in the same hospital was not responsible for these interhospital differences. CONCLUSION: The effect of the specific hospital on transfusion practice is attributed to institutional differences that, through reasons of training or hierarchy, become ingrained in hospitals.

Original languageEnglish (US)
Pages (from-to)122-134
Number of pages13
JournalTransfusion
Volume38
Issue number2
StatePublished - Feb 1998
Externally publishedYes

Fingerprint

Cellular Structures
Coronary Artery Bypass
Transplants
Blood Component Transfusion
Sex Factors
Hospital Units
Mammary Arteries
Diagnosis-Related Groups
Teaching Hospitals
Catheterization
Blood Transfusion
Logistic Models
Odds Ratio

ASJC Scopus subject areas

  • Hematology
  • Immunology

Cite this

Surgenor, D. M., Churchill, W. H., Wallace, E. L., Rizzo, R. J., McGurk, S., Goodnough, L. T., ... Woodson, R. D. (1998). The specific hospital significantly affects red cell and component transfusion practice in coronary artery bypass graft surgery: A study of five hospitals. Transfusion, 38(2), 122-134.

The specific hospital significantly affects red cell and component transfusion practice in coronary artery bypass graft surgery : A study of five hospitals. / Surgenor, D. M.; Churchill, W. H.; Wallace, E. L.; Rizzo, R. J.; McGurk, S.; Goodnough, L. T.; Kao, K. J.; Koerner, T. A W; Olson, John D; Woodson, R. D.

In: Transfusion, Vol. 38, No. 2, 02.1998, p. 122-134.

Research output: Contribution to journalArticle

Surgenor, DM, Churchill, WH, Wallace, EL, Rizzo, RJ, McGurk, S, Goodnough, LT, Kao, KJ, Koerner, TAW, Olson, JD & Woodson, RD 1998, 'The specific hospital significantly affects red cell and component transfusion practice in coronary artery bypass graft surgery: A study of five hospitals', Transfusion, vol. 38, no. 2, pp. 122-134.
Surgenor, D. M. ; Churchill, W. H. ; Wallace, E. L. ; Rizzo, R. J. ; McGurk, S. ; Goodnough, L. T. ; Kao, K. J. ; Koerner, T. A W ; Olson, John D ; Woodson, R. D. / The specific hospital significantly affects red cell and component transfusion practice in coronary artery bypass graft surgery : A study of five hospitals. In: Transfusion. 1998 ; Vol. 38, No. 2. pp. 122-134.
@article{08dbcef5dc6b42448fc3211d5386654b,
title = "The specific hospital significantly affects red cell and component transfusion practice in coronary artery bypass graft surgery: A study of five hospitals",
abstract = "BACKGROUND: Interhospital differences in blood transfusion practice during coronary artery bypass graft (CABG) surgery have been noted, but the underlying issues have not been identified. STUDY DESIGN AND METHODS: Records of 3217 consecutive CABG cases in five university teaching hospitals in 1992 and 1993 were stratified by hospital, type of revascularization conduit, patients sex, and other factors. Statistical methods were used to compare patient characteristics, transfusion outcomes, and hospital outcomes. RESULTS: Forward two-step logistic regression using patient likelihood of red cell transfusion factors in the first step and the specific hospital in the second step revealed a significant effect of hospital on the Δ odds ratios for red cell transfusion. This finding was confirmed by analyses of a highly stratified subset of cases, males in diagnosis-related group 107 (primary cases of coronary bypass without coronary catheterization) who underwent revascularization with venous and internal mammary artery grafts, revealing variations among hospitals from 109 to 457 units of red cells transfused per hundred cases. Corresponding variations in transfusions of all blood components were from 324 to 1019 units by hospital. Variation in red cell transfusion practice among surgeons in the same hospital was not responsible for these interhospital differences. CONCLUSION: The effect of the specific hospital on transfusion practice is attributed to institutional differences that, through reasons of training or hierarchy, become ingrained in hospitals.",
author = "Surgenor, {D. M.} and Churchill, {W. H.} and Wallace, {E. L.} and Rizzo, {R. J.} and S. McGurk and Goodnough, {L. T.} and Kao, {K. J.} and Koerner, {T. A W} and Olson, {John D} and Woodson, {R. D.}",
year = "1998",
month = "2",
language = "English (US)",
volume = "38",
pages = "122--134",
journal = "Transfusion",
issn = "0041-1132",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - The specific hospital significantly affects red cell and component transfusion practice in coronary artery bypass graft surgery

T2 - A study of five hospitals

AU - Surgenor, D. M.

AU - Churchill, W. H.

AU - Wallace, E. L.

AU - Rizzo, R. J.

AU - McGurk, S.

AU - Goodnough, L. T.

AU - Kao, K. J.

AU - Koerner, T. A W

AU - Olson, John D

AU - Woodson, R. D.

PY - 1998/2

Y1 - 1998/2

N2 - BACKGROUND: Interhospital differences in blood transfusion practice during coronary artery bypass graft (CABG) surgery have been noted, but the underlying issues have not been identified. STUDY DESIGN AND METHODS: Records of 3217 consecutive CABG cases in five university teaching hospitals in 1992 and 1993 were stratified by hospital, type of revascularization conduit, patients sex, and other factors. Statistical methods were used to compare patient characteristics, transfusion outcomes, and hospital outcomes. RESULTS: Forward two-step logistic regression using patient likelihood of red cell transfusion factors in the first step and the specific hospital in the second step revealed a significant effect of hospital on the Δ odds ratios for red cell transfusion. This finding was confirmed by analyses of a highly stratified subset of cases, males in diagnosis-related group 107 (primary cases of coronary bypass without coronary catheterization) who underwent revascularization with venous and internal mammary artery grafts, revealing variations among hospitals from 109 to 457 units of red cells transfused per hundred cases. Corresponding variations in transfusions of all blood components were from 324 to 1019 units by hospital. Variation in red cell transfusion practice among surgeons in the same hospital was not responsible for these interhospital differences. CONCLUSION: The effect of the specific hospital on transfusion practice is attributed to institutional differences that, through reasons of training or hierarchy, become ingrained in hospitals.

AB - BACKGROUND: Interhospital differences in blood transfusion practice during coronary artery bypass graft (CABG) surgery have been noted, but the underlying issues have not been identified. STUDY DESIGN AND METHODS: Records of 3217 consecutive CABG cases in five university teaching hospitals in 1992 and 1993 were stratified by hospital, type of revascularization conduit, patients sex, and other factors. Statistical methods were used to compare patient characteristics, transfusion outcomes, and hospital outcomes. RESULTS: Forward two-step logistic regression using patient likelihood of red cell transfusion factors in the first step and the specific hospital in the second step revealed a significant effect of hospital on the Δ odds ratios for red cell transfusion. This finding was confirmed by analyses of a highly stratified subset of cases, males in diagnosis-related group 107 (primary cases of coronary bypass without coronary catheterization) who underwent revascularization with venous and internal mammary artery grafts, revealing variations among hospitals from 109 to 457 units of red cells transfused per hundred cases. Corresponding variations in transfusions of all blood components were from 324 to 1019 units by hospital. Variation in red cell transfusion practice among surgeons in the same hospital was not responsible for these interhospital differences. CONCLUSION: The effect of the specific hospital on transfusion practice is attributed to institutional differences that, through reasons of training or hierarchy, become ingrained in hospitals.

UR - http://www.scopus.com/inward/record.url?scp=6844237645&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=6844237645&partnerID=8YFLogxK

M3 - Article

C2 - 9531943

AN - SCOPUS:6844237645

VL - 38

SP - 122

EP - 134

JO - Transfusion

JF - Transfusion

SN - 0041-1132

IS - 2

ER -