VARIABILITY IN TRANSFUSION PRACTICE FOR CORONARY-ARTERY BYPASS-SURGERY PERSISTS DESPITE NATIONAL CONSENSUS GUIDELINES - A 24-INSTITUTION STUDY

Background: An estimated 20% of allogeneic blood transfusions in the U nited States are associated with cardiac surgery National consensus gu idelines for allogeneic transfusion associated with coronary artery by pass graft (CABG) surgery have existed since the mid-to late 1980s. Th e appropriateness and uniformity of institutional transfusion practice was questioned in 1991. An assessment of current transfusion practice patterns was warranted. Methods: The Multicenter Study of Perioperati ve Ischemia database consists of comprehensive information on the cour se of surgery in 2,417 randomly selected patients undergoing CABG surg ery at 24 institutions. A subset of 713 patients expected to be at low risk for transfusion was examined Allogeneic transfusion was evaluate d across institutions. Institution as an independent risk factor for a llogeneic transfusion was determined in a multivariable model. Results : Significant. variability in institutional transfusion practice was o bserved for allogeneic packed red blood cells (PRBCs) (27-92% of patie nts transfused) and hemostatic blood components (platelets, 0-36%; fre sh frozen plasma, 0-36%; cryoprecipitate, 0-17% of patients transfused ). For patients at institutions with liberal rather than conservative transfusion practice, the odds ratio for transfusion of PRBCs was 6.5 (95% confidence interval [CI], 3.8-10.8) and for hemostatic blood comp onents it was 2 (95% CI, 1.2-3.4). Institution was an independent dete rminant of transfusion risk associated with CABG surgery.Conclusions: Institutions continue to vary significantly in their transfusion pract ices for CABG surgery. A mote rational and conservative approach to tr ansfusion practice at the institutional level is warranted.