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American Journal of Medical Quality
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Institutional Variability of Intraoperative Red Blood Cell Utilization in Coronary Artery Bypass Graft Surgery

Franklin W. Maddux, MD, FACP

Specialty Care Services Group, Nashville, Tennessee, and Hospital Clinical Services Group, Brentwood, Tennessee, frank.maddux{at}specialtycaresg.com

Timothy A. Dickinson, MS

Hospital Clinical Services Group, Brentwood, Tennessee.

Dirck Rilla, BS, CCP

Hospital Clinical Services Group, Brentwood, Tennessee.

Robert W. Kamienski, MD

Akron General Medical Center, Akron, Ohio

Sibu P. Saha, MD, MBA

Dr Saha is from University of Kentucky, Lexington, Kentucky

Frazier Eales, MD

Minnesota Thoracic Associates, Minneapolis, Minnesota

Alfredo Rego, MD, PhD

South Florida Heart and Lung Institute, Aventura, Florida

Harry W. Donias, MD

Cardiovascular Surgery of Southern Nevada, Las Vegas, Nevada

Susan L. Crutchfield, MSN, EdD, FACHE

Specialty Care Services Group, Nashville, Tennessee, and Hospital Clinical Services Group, Brentwood, Tennessee

Robert A. Hardin, MD

Hospital Clinical Services Group, Brentwood, Tennessee.

The variability in frequency of allogeneic blood transfusion during coronary artery bypass surgery (CABG) is a concern. Evidence-based guidelines support minimizing the use of blood during open heart surgery. The Hospital Clinical Services Group quality indicator database was queried for intraoperative red blood cell (RBC) transfusions in 17 252 isolated CABG surgery cases during 2007. Institutional variability was observed in the frequency of intraoperative RBC transfusion rates, which ranged from 0% to 85.7%. The institution mean RBC transfusion rate was 40.8%. Regional geographic and cardiac program size variations were observed in RBC transfusion rates and volume with significant variation. Notable institutional variability persists with respect to intraoperative RBC transfusion in isolated CABG surgery despite clear evidence and guidelines to support techniques to minimize RBC transfusion. Such results support the hypothesis that incorporating evidence-based transfusion-related practices in open heart surgery are not uniformly adopted.

Key Words: evidence-based medicine • blood transfusion • coronary artery bypass surgery • open heart surgery • cardiopulmonary bypass • CABG

This version was published on September 1, 2009

American Journal of Medical Quality, Vol. 24, No. 5, 403-411 (2009)
DOI: 10.1177/1062860609339384
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