Effect of Hospital Culture on Blood Transfusion in Cardiac Procedures

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Effect of Hospital Culture on Blood Transfusion in Cardiac Procedures Ruyun Jin, MD, MCR, Edy S. Zelinka, CCP, Julie McDonald, BSN, Thomas Byrnes, BS, Gary L. Grunkemeier, PhD, James Brevig, MD The Annals of Thoracic Surgery Volume 95, Issue 4, Pages 1269-1274 (April 2013) DOI: 10.1016/j.athoracsur.2012.08.008 Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Red blood cells (RBC) transfusion rate vs annual volume by surgeon. (PH&S-CDSG = Providence Health & Services Cardiovascular Disease Study Group.) The Annals of Thoracic Surgery 2013 95, 1269-1274DOI: (10.1016/j.athoracsur.2012.08.008) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Red blood cells (RBC) transfusion rates by surgeon by facility. Each circle represents a surgeon; surgeons from the same facility are shown in the same column with the same color. The red horizontal lines indicate the mean values for each facility. The area of each circle is proportional to the surgeon's volume. (CABG = coronary artery bypass grafting.) The Annals of Thoracic Surgery 2013 95, 1269-1274DOI: (10.1016/j.athoracsur.2012.08.008) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Units of red blood cells (RBC) transfused per 100 coronary artery bypass grafting (CABG) operations, by surgeon by facility. The red horizontal lines indicate the mean values for each facility. The area of each circle is proportional to the surgeon's volume. The Annals of Thoracic Surgery 2013 95, 1269-1274DOI: (10.1016/j.athoracsur.2012.08.008) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Type of blood components transfused by surgeon. Other blood products include fresh frozen plasma, platelets, and cryoprecipitate. Surgeons are grouped by hospital, indicated by the alternating vertical shaded panels. The widths of the bars represent surgeon volumes. (CABG = coronary artery bypass graft; RBC = red blood cells.) The Annals of Thoracic Surgery 2013 95, 1269-1274DOI: (10.1016/j.athoracsur.2012.08.008) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Timing of red blood cells (RBC) transfusion by surgeon. Surgeons are grouped by hospital, indicated by the alternating vertical shaded panels. The widths of the bars represent surgeon volumes. (CABG = coronary artery bypass grafting.) The Annals of Thoracic Surgery 2013 95, 1269-1274DOI: (10.1016/j.athoracsur.2012.08.008) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Overall red blood cells (RBC) transfusion rates by percentage of RBC that was given intraoperatively. Surgeons who tended to withhold RBC transfusions intraoperatively (toward the left end of the x-axis) had significantly lower overall RBC transfusion rates (p < 0.001). (PH&S-CDSG = Providence Health & Services Cardiovascular Disease Study Group.) The Annals of Thoracic Surgery 2013 95, 1269-1274DOI: (10.1016/j.athoracsur.2012.08.008) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions