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TRENDS AND VARIATION IN TRANSFUSION RATES FOLLOWING CARDIAC SURGERY IN BRITISH COLUMBIA, 2009 TO 2013
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who did not, and those requiring readmission vs. those who did not (Figure 1. p>0.05). There was a difference amongst satisfaction between older (age65) and younger (age<65) (Figure 1. 3.80 vs. 3.48, p¼0.011). CONCLUSION: In post-operative CS patients, FP or internists managed most outpatient complications. Similarly, almost all patients requiring admission to hospital were admitted through the ED and managed by physicians other than their surgeon. Despite evidence that patients were well-managed by FP, the local ED and internists, patients strongly felt that a visit to their surgeon post-operatively was of great importance.
Canadian Journal of Cardiology Volume 30 2014
181 TRENDS AND VARIATION IN TRANSFUSION RATES FOLLOWING CARDIAC SURGERY IN BRITISH COLUMBIA, 2009 TO 2013 CH Ng, J Shin, L Ding Vancouver, British Columbia BACKGROUND:
Observational studies have shown an increased risk of morbidity and mortality in patients receiving blood transfusions following cardiac surgery, and recent trials have shown that restrictive transfusion practices are equivalent or better than liberal practices. Given donor blood is a costly and limited resource, administering blood transfusions more efficiently and appropriately is a priority. However, there is a lack of data available on current transfusion practices in Canada to help guide quality improvement efforts. The purpose of this study was to determine the trends and patterns of transfusion practice for adult cardiac surgeries in the province of British Columbia, Canada. METHODS: Data on isolated CABG, isolated valve, and CABG+valve surgeries for patients aged 20 and older from Jan 1, 2009 to Dec 31, 2013 from the provincial cardiac registry (HEARTis) were linked to the provincial Central Transfusion Registry (CTR) to obtain data on blood transfusions within 30 days of surgery. Trends were examined by type of surgery and by blood component. Variation in transfusion rates was also assessed by surgeon. RESULTS: From 2009 to 2013, the rate of RBC transfusion declined from 44.6% to 31.4% for isolated CABG, 42.8% to 35.5% for isolated valve, and 65.2% to 52.3% for CABG+valve surgeries. The total units of RBC transfused also decreased during this period. The proportion of patients receiving plasma and platelets following surgery has also decreased during this time. Despite the decline in transfusion rates, there remains large variation in rates for individual surgeons. Transfusion rates following isolated CABG surgery ranged from 18.2% to 57.5% for RBC, 3.5% to 41.0% for platelets, and 5.3% to 38.3% for plasma. Although some of this variation can likely be attributed to the patient mix of risk factors, transfusion rates as high as 57.5% for RBC is unlikely to be driven by clinical factors alone. CONCLUSION: RBC transfusion rates have been on the decline in British Columbia in recent years, with a 13.2% decrease from 2009 to 2013. More modest decreases in plasma and platelet transfusion rates were observed during this time. There was wide variation in transfusion rates for RBC, plasma, and platelets between surgeons. The observed variation provides an opportunity to examine patient risk factors as well as hospital and surgeon practices that contribute to this variation, in order to identify ways to avoid unnecessary transfusions. 182 CHARACTERISTICS, LONG TERM SURVIVAL AND PREDICTORS OF MORTALITY OF PATIENTS NEEDING PROLONGED INTENSIVE UNIT CARE STAY POST CARDIAC SURGERY RA Manji, BM Hiebert, RC Arora, MC Moon, DH Freed, AH Menkis Winnipeg, Manitoba
who did not, and those requiring readmission vs. those who did not (Figure 1. p>0.05). There was a difference amongst satisfaction between older (age65) and younger (age<65) (Figure 1. 3.80 vs. 3.48, p¼0.011). CONCLUSION: In post-operative CS patients, FP or internists managed most outpatient complications. Similarly, almost all patients requiring admission to hospital were admitted through the ED and managed by physicians other than their surgeon. Despite evidence that patients were well-managed by FP, the local ED and internists, patients strongly felt that a visit to their surgeon post-operatively was of great importance.
Canadian Journal of Cardiology Volume 30 2014
181 TRENDS AND VARIATION IN TRANSFUSION RATES FOLLOWING CARDIAC SURGERY IN BRITISH COLUMBIA, 2009 TO 2013 CH Ng, J Shin, L Ding Vancouver, British Columbia BACKGROUND:
Observational studies have shown an increased risk of morbidity and mortality in patients receiving blood transfusions following cardiac surgery, and recent trials have shown that restrictive transfusion practices are equivalent or better than liberal practices. Given donor blood is a costly and limited resource, administering blood transfusions more efficiently and appropriately is a priority. However, there is a lack of data available on current transfusion practices in Canada to help guide quality improvement efforts. The purpose of this study was to determine the trends and patterns of transfusion practice for adult cardiac surgeries in the province of British Columbia, Canada. METHODS: Data on isolated CABG, isolated valve, and CABG+valve surgeries for patients aged 20 and older from Jan 1, 2009 to Dec 31, 2013 from the provincial cardiac registry (HEARTis) were linked to the provincial Central Transfusion Registry (CTR) to obtain data on blood transfusions within 30 days of surgery. Trends were examined by type of surgery and by blood component. Variation in transfusion rates was also assessed by surgeon. RESULTS: From 2009 to 2013, the rate of RBC transfusion declined from 44.6% to 31.4% for isolated CABG, 42.8% to 35.5% for isolated valve, and 65.2% to 52.3% for CABG+valve surgeries. The total units of RBC transfused also decreased during this period. The proportion of patients receiving plasma and platelets following surgery has also decreased during this time. Despite the decline in transfusion rates, there remains large variation in rates for individual surgeons. Transfusion rates following isolated CABG surgery ranged from 18.2% to 57.5% for RBC, 3.5% to 41.0% for platelets, and 5.3% to 38.3% for plasma. Although some of this variation can likely be attributed to the patient mix of risk factors, transfusion rates as high as 57.5% for RBC is unlikely to be driven by clinical factors alone. CONCLUSION: RBC transfusion rates have been on the decline in British Columbia in recent years, with a 13.2% decrease from 2009 to 2013. More modest decreases in plasma and platelet transfusion rates were observed during this time. There was wide variation in transfusion rates for RBC, plasma, and platelets between surgeons. The observed variation provides an opportunity to examine patient risk factors as well as hospital and surgeon practices that contribute to this variation, in order to identify ways to avoid unnecessary transfusions. 182 CHARACTERISTICS, LONG TERM SURVIVAL AND PREDICTORS OF MORTALITY OF PATIENTS NEEDING PROLONGED INTENSIVE UNIT CARE STAY POST CARDIAC SURGERY RA Manji, BM Hiebert, RC Arora, MC Moon, DH Freed, AH Menkis Winnipeg, Manitoba