Wide interhospital variation exists in cardiac surgical postoperative transfusion rates. We aimed to compare transfusion rates at 2 hospitals and identify the institutional practice factors, unrelated to patient or operative characteristics, associated with postoperative transfusion rates. Records for adult patients undergoing routine cardiac surgery at 2 hospitals (H and L) from February 2020 to August 2022 were analyzed. Patient and operative characteristics, preoperative and intensive care unit hemoglobin values, and postoperative transfusion rates were compared. Transfusion indication was recorded prospectively. Propensity matching was completed to assess comparability of patient populations. After propensity matching patients at H and L on age, procedure type, predicted morbidity or mortality, crossclamp time, preoperative hypertension, preoperative heart failure, and preoperative stroke, 2111 patients remained, with similar characteristics except hypertension. Matched results showed no significant differences in mortality, reoperation, or other major outcomes. Hospital H transfused 36% of patients (mean postoperative hemoglobin [Hb] 10.5) with 1483 units of packed red blood cells whereas hospital L transfused 12% of patients (mean postoperative Hb 9.4) with 198 units of packed red blood cells ( < .001). For all patients with a Hb >7.5, hospital H versus L transfused 27% versus 0.9% ( < .001). Hospital L’s sole transfusion indication for pretransfusion hemoglobin trigger >7.5 was bleeding versus hospital H, which had multiple indications. When Hb concentration alone was the indication for transfusion, the threshold at hospital H was <7.5 g/dL versus <6 g/dL at hospital L. Variation in transfusion rates between hospitals H and L resulted from strict adherence at hospital L to a transfusion trigger of <6 g/dL with narrow indications for transfusions above that Hb concentration.

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是什么导致了心脏手术术后输血率的变异？

心脏手术术后输血率存在较大的医院间差异。我们的目的是比较两家医院的输血率，并确定与患者或手术特征无关但与术后输血率相关的机构实践因素。对 2020 年 2 月至 2022 年 8 月期间在 2 家医院（H 和 L）接受常规心脏手术的成年患者的记录进行了分析。比较患者和手术特征、术前和重症监护室血红蛋白值以及术后输血率。前瞻性记录输血指征。完成倾向匹配以评估患者群体的可比性。在对 H 和 L 患者的年龄、手术类型、预测发病率或死亡率、交叉钳夹时间、术前高血压、术前心力衰竭和术前卒中进行倾向匹配后，仍有 2111 名患者具有相似的特征（高血压除外）。匹配结果显示死亡率、再次手术或其他主要结局没有显着差异。医院 H 为 36% 的患者（平均术后血红蛋白 [Hb] 10.5）输注 1483 单位浓缩红细胞，而医院 L 为 12% 的患者（平均术后 Hb 9.4）输注 198 单位浓缩红细胞 ( < .001 ）。对于所有 Hb >7.5 的患者，医院 H 输血与 L 输血分别为 27% 和 0.9% (< .001)。L 医院输血前血红蛋白触发值 >7.5 的唯一输血指征是出血，而 H 医院则有多种指征。当仅 Hb 浓度作为输血指征时，H 医院的阈值<7.5 g/dL，而 L 医院的阈值<6 g/dL。H 医院和 L 医院之间输血率的差异是由于 L 医院严格遵守输血所致<6 g/dL 的触发点，高于该 Hb 浓度的输血适应症狭窄。