Issue |
J Extra Corpor Technol
Volume 53, Number 4, December 2021
|
|
---|---|---|
Page(s) | 270 - 278 | |
DOI | https://doi.org/10.1051/ject/202153270 | |
Published online | 15 December 2021 |
Original Articles
Risk and Safety Perceptions Contribute to Transfusion Decisions in Coronary Artery Bypass Grafting
* Michigan Medicine, Ann Arbor, Michigan;
† Department of Neurology, Michigan Medicine, Ann Arbor, Michigan;
‡ Division of Cardiac Surgery, Henry Ford Hospital, Detroit, Michigan;
§ Division of Cardiothoracic Surgery, Maine Medical Center, Portland, Maine;
² Department of Cardiac Surgery, Bronson Methodist Hospital, Kalamazoo, Michigan;
¶ Department of Blood Management, Bronson Methodist Hospital, Kalamazoo, Michigan;
# Department of Biostatistics, University of Michigan, Ann Arbor, Michigan;
** Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan; and
†† Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Michigan
Address correspondence to: Donald S. Likosky, PhD, Section of Health Services Research and Quality, Department of Cardiac Surgery (5346 CVC), Michigan Medicine, 1500 E Medical Center Dr., Ann Arbor, MI 48109-5864. E-mail: likosky@umich.edu
Received:
7
April
2021
Accepted:
16
August
2021
Variability persists in intraoperative red blood cell (RBC) transfusion rates, despite evidence supporting associated adverse sequelae. We evaluated whether beliefs concerning transfusion risk and safety are independently associated with the inclination to transfuse. We surveyed intraoperative transfusion decision-makers from 33 cardiac surgery programs in Michigan. The primary outcome was a provider’s reported inclination to transfuse (via a six-point Likert Scale) averaged across 10 clinical vignettes based on Class IIA or IIB blood management guideline recommendations. Survey questions assessed hematocrit threshold for transfusion (“hematocrit trigger”), demographic and practice characteristics, years and case-volume of practice, knowledge of transfusion guidelines, and provider attitude regarding perceived risk and safety of blood transfusions. Linear regression models were used to estimate the effect of these variables on transfusion inclination. Mixed effect models were used to quantify the variation attributed to provider specialties and hematocrit triggers. The mean inclination to transfuse was 3.2 (might NOT transfuse) on the survey Likert scale (SD: .86) across vignettes among 202/413 (48.9%) returned surveys. Hematocrit triggers ranged from 15% to 30% (average: 20.4%; SE: .18%). The inclination to transfuse in situations with weak-to-moderate evidence for supporting transfusion was associated with a provider’s hematocrit trigger (p < .01) and specialty. Providers believing in the safety of transfusions were significantly more likely to transfuse. Provider specialty and belief in transfusion safety were significantly associated with a provider’s hematocrit trigger and likelihood for transfusion. Our findings suggest that blood management interventions should target these previously unaccounted for blood transfusion determinants.
Key words: CABG / blood transfusion / transfusion / RBC / intraoperative
The senior author has stated that Darin Zahuranec received grant support from NIH (K23AG038731) and that Donald S. Likosky received grant support from AHRQ and NIH, is a consultant to AmSECT, and receives partial salary support from Blue Cross/Shield of Michigan to advance quality through the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative. Dr. Strobel is presently a resident physician in cardiothoracic surgery at the University of Virginia (Charlottesville, VA). Dr. Loh is presently a resident physician at Cleveland Clinic (Cleveland, OH). Dr. Paone is presently an attending physician at Emory University (Atlanta, GA). Mr. Behr presently works at Lehigh Valley Health Network (Allentown, PA).
© 2021 AMSECT
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