THE COLLABORATIVE HOSPITAL TRANSFUSION STUDY - VARIATIONS IN USE OF AUTOLOGOUS BLOOD ACCOUNT FOR HOSPITAL DIFFERENCES IN RED-CELL USE DURING PRIMARY HIP AND KNEE SURGERY

BACKGROUND: Red cell use in patients undergoing Diagnosis Related Grou p (DRG) 209 procedures (major joint and limb reconstruction procedures of the lower extremities) has been shown to have large, unexplained i nterhospital variations.STUDY DESIGN AND METHODS: Abstracted records o f 2590 consecutive DRG 209 patients at five university hospitals from January 1992 to December 1993 were stratified by procedure and preoper ative blood deposit status. Patient characteristics and transfusion an d in-hospital outcomes were compared across hospitals. RESULTS: Blood use among patients who did not preoperatively deposit blood was simila r across hospitals. Significant differences were found across hospital s for total hip replacement patients in the percentage of patients pre operatively depositing blood (59-80%), percentage of patients receivin g transfusion(s) (51 to >99%), the mean number of units collected per patient (1.6-2.9), and the mean number of unused autologous units per 100 patients (1-185). No significant differences were found in the per centage of those who deposited blood and then required allogeneic unit s. There was little variability in length of hospital stay or in last hematocrits. Findings were similar for total knee replacement patients . CONCLUSIONS: Interhospital variations in red cell use for primary to tal hip and knee reconstruction are primarily due to hospital-specific differences in autologous blood collection and transfusion.