Abstract 11988: Trends and Variation of Red Blood Cell Transfusion in Coronary Artery Bypass Grafting in China, 2014-2019

Abstract

Introduction: Red blood cell (RBC) transfusion is common for cardiac surgeries, but safety problems are of concern, and some countries have taken initiatives to limit RBC use. The trends and variation of RBC transfusion in coronary artery bypass grafting (CABG) across China remain unknown, which is essential for quality control on reducing unnecessary transfusion. Hypothesis: To assess recent trends of perioperative RBC transfusion and variation across hospitals and surgeons among patients undergoing elective isolated CABG. Methods: We used data from a national CABG registry with detailed clinical information of patients undergoing elective isolated CABG between 2014 and 2019. The overall and hospital-level rates of perioperative RBC transfusion were described and compared across study years. Hierarchical models were used to make risk-adjusted between-hospital comparison, and to quantify variations derived from hospitals and surgeons. Results: A total of 47554 CABG patients from 72 hospitals were included, with a mean age of 62.7 (standard deviation [SD]: 8.8) years and 75.4% were male. The overall perioperative RBC transfusion rate was 43.9% during the study period. A remarkable decline of RBC transfusion from 51.6% in 2014 to 39.8% in 2019 (P for trend<0.001) was observed, along with the mean hospital-level transfusion rate declined from 56.6% (SD: 26.9%) to 48.1% (SD: 26.1%), and minimal amounts (1-2 units) of RBC declined from 21.9% (SD: 16.3%) to 18.3% (SD: 13.1%). Hospital-level intraoperative transfusion had a similar decreasing amplitude (from 34.8% to 28.7%) with postoperative transfusion (from 38.7% to 32.4%), and the Pearson correlation coefficient was 0.32 (P<0.01). After risk adjustment of patient characteristics, the median odds ratio (MOR) of perioperative RBC transfusion between hospitals was 3.9 in 2014 and reduced to 3.2 in 2019. Furtherly, the relative proportion of variation hospitals explained decreased from 88.0% to 76.0% while increased for surgeons from 12.0% to 24.0%. Conclusions: There is a considerable decline of perioperative RBC transfusion in CABG patients in China during last few years, with notable reductions in between-hospital variation. However, strategies to narrow between-surgeon variation are required.