Key result
Intraoperative blood transfusion rates were inversely associated with adjusted 30-day postoperative mortality, showing a 0.7% decrease per 10% increase in transfusion rate (95% CI 0.3%-1.1%).
Why the study?
Do higher hospital-level rates of intraoperative blood transfusion reduce 30-day postoperative mortality in older patients with significant surgical blood loss?
Observational (n=46,608)
Yes
Do higher hospital-level rates of intraoperative blood transfusion reduce 30-day postoperative mortality in older patients with significant surgical blood loss?
Effect estimate: 0.7% decrease per 10% increase (95% CI 0.3%-1.1%)
Higher hospital-level intraoperative blood transfusion rates for older patients with significant surgical blood loss are associated with lower 30-day postoperative mortality.
Should not yet change transfusion practice; leaves open whether higher rates causally reduce mortality in high-blood-loss surgery.
OBJECTIVE: Blood loss during surgery is an important operative complication in patients undergoing major noncardiac surgery and may increase postoperative morbidity and mortality. Variations in the delivery of operative blood transfusions to treat blood loss depend not only on the patient and surgery characteristics but also on the hospital transfusion practices, and may explain differences in the hospitals' postoperative outcomes. We determine the relationship between hospital-level rates of intraoperative blood transfusion and 30-day mortality among older patients with significant intraoperative blood loss. METHODS: Among 46,608 operative patients aged 65 years or older whose estimated blood loss was 500 mL or greater in 122 Veterans Affairs (VA) hospitals during years 1997 to 2004, we examined the relationship between hospital-level transfusion rates and adjusted 30-day postoperative mortality rates using linear regression modeling. RESULTS: Hospital-level rates of intraoperative blood transfusion for older surgical patients with significant blood loss varied from 10% to 92%. Hospitals in the highest tertile for the rate of intraoperative transfusion had the highest number of patients with 500 mL or more surgical blood loss and lowest risk-adjusted 30-day surgical mortality. For every 10% increase in the rate of intraoperative blood transfusion, there was a 0.7% (95% CI: 0.3%-1.1%) decrease in the hospital's adjusted 30-day postoperative mortality for these high-risk patients. CONCLUSIONS: Large variation exists in hospitals' intraoperative blood transfusion practices for older patients with significant surgical blood loss. Hospitals with higher transfusion rates for patients with significant surgical blood loss have lower adjusted 30-day mortality for these patients. Hospital intraoperative blood transfusion practices may be a promising surgical quality indicator.
No takes yet. Share an insight, caveat, or question.
Wu et al. (2012) conducted an observational in Surgical blood loss (n=46,608). Intraoperative blood transfusion vs. Lower transfusion rates was evaluated on Adjusted 30-day postoperative mortality (0.7% decrease per 10% increase, 95% CI 0.3%-1.1%). Intraoperative blood transfusion rates were inversely associated with adjusted 30-day postoperative mortality, showing a 0.7% decrease per 10% increase in transfusion rate (95% CI 0.3%-1.1%).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: