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TECHNOLOGIES TO MINIMIZE BLOOD TRANSFUSION IN CARDIAC AND ORTHOPEDIC SURGERY

Results of a Practice Variation Survey in Nine Countries

Published online by Cambridge University Press:  01 October 1999

Dean Fergusson ,
Angela Blair ,
David Henry ,
Akinori Hisashige ,
Charlotte Huet ,
Ankie Koopman-van Gemert ,
Edna Katz ,
Brian McClelland ,
Helga Sigmund  and
Andreas Laupacis
Dean Fergusson
Affiliation:
Loeb Health Research Institute
Angela Blair
Affiliation:
Grady Memorial Hospital
David Henry
Affiliation:
University of Newcastle
Akinori Hisashige
Affiliation:
Kawasaki Medical School and University of Tokushima
Charlotte Huet
Affiliation:
Université Bordeaux II
Ankie Koopman-van Gemert
Affiliation:
Alberta Schweitzerhospital, Dordrecht
Edna Katz
Affiliation:
B'nai Zion Medical Centre
Brian McClelland
Affiliation:
Edinburgh and SE Scotland Blood Transfusion Service
Helga Sigmund
Affiliation:
Danish Institute for Health Technology Assessment
Andreas Laupacis
Affiliation:
The Ottawa Hospital
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Abstract

Objectives: Due to the discovery in the 1980s that blood transfusion can transmit HIV, there has been increased interest in technologies that reduce the amount of allogeneic blood used during and after surgery. These technologies include drugs (aprotinin, tranexamic acid, epsilon-aminocaproic acid, erythropoietin), devices (cell salvage), and techniques (acute hemodilution, predeposited autologous donation). The purpose of this study was to ascertain the degree of practice variation, if any, that exists for eight technologies in nine countries in orthopedic and cardiac surgery.

Methods: In each country, either all hospitals or a random sample of hospitals with medical/surgical beds were surveyed between 1995 and 1997. Two instruments were used. The first instrument was a postcard that asked recipients whether the technologies were currently being used in their hospital for orthopedic and/or cardiac surgery to reduce perioperative allogeneic transfusion. The second questionnaire elicited information regarding the degree of use both in qualitative and quantitative terms. Data were collected, entered, and analyzed in each country, with summary results submitted to the Canadian coordinating center on a standardized data collection form.

Results: Pharmaceuticals were generally used in a much smaller proportion of hospitals in orthopedic than in cardiac surgery. Aprotinin and tranexamic acid were the drugs most frequently used in cardiac surgery. Nonpharmacological technologies were used to a greater degree than drugs in orthopedic surgery, although there was wide variation among technologies and countries. Acute hemodilution and cell salvage were used in a greater proportion of hospitals for cardiac surgery than orthopedic surgery.

Conclusions: The results of this survey indicate that there is considerable practice variation in the use of technologies to minimize exposure to perioperative allogeneic transfusion within and between countries.

Keywords

Practice variationBlood transfusionOrthopedic surgeryCardiac surgeryPerioperative
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 15 , Issue 4 , October 1999 , pp. 717 - 728
Copyright
© 1999 Cambridge University Press

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Footnotes

Dr. Laupacis is the recipient of the First Fellowship from the International Society of Technology Assessment in Health Care, funded by the PPP Medical Trust, United Kingdom. The Ottawa Coordinating Centre has been funded by Janssen Ortho Inc, Canada. Dr. Laupacis is a Scientist of the Medical Research Council of Canada (MRC), Drs. Hebert, O'Connor, and Graham are Career Scientists of the Ontario Ministry of Health, and Dr. Phil Wells is the recipient of a Fellowship from the Heart and Stroke Foundation of Ontario.
The International Study of Peri-operative Transfusion (ISPOT) Investigators includes the following members. Coordinating Centre and Canadian Investigators Phil Wells, M.D.; George Wells, Ph.D.; Fraser Rubens, M.D.; Annette O'Connor, Ph.D.; Laura McAuley, B.Sc.; Andreas Laupacis, M.D. (Chair); Paul Hébert, M.D.; Ian Graham, Ph.D.; Dean Fergusson, M.H.A. (Coordinator); and Greg Bryson, M.D.; Clinical Epidemiology Unit, Loeb Health Research Institute, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, Ontario, Canada, K1Y 4E9. United States: Christopher D. Hillyer, M.D., Emory University Hospital Blood Bank, Emory University Hospital, Atlanta, GA; and Angela Blair, M.P.H., Center for Clinical Effectiveness, Grady Memorial Hospital, Atlanta, GA. United Kingdom: Brian McClelland, M.D.; and Patricia Phillips; SES Scotland Transfusion Service, Department of Transfusion Medicine, Royal Infirmary, Lauriston Place, Edinburgh, Scotland, EH3 9HB Spain: Jordi Gol-Freixa, M.D.; and Antonio Gracia; Agencia de Evaluación de Tecnologías Sanitarias, Ministerio de Sanidad Consumo, Sinesio Delgado 6, PAB 3, 28029, Madrid, Spain. The Netherlands: Ankie Koopman-van Gemert, M.D., Ph.D., Breeweg 15, 1251 DX Laren, The Netherlands. Japan: Akinori Hisashige, M.D., Ph.D.; and Hiroaki Mikasa, Ph.D., Department of Preventive Medicine, 3-18-15 Kuramoto, Todushima, 770, Japan. Masuhiko Takasugi, M.D., Ph.D., Kawasaki Medical School, Okayama, Japan. Israel: Nachum Egoz, M.D., M.P.H.; Luis Gaitini, M.D.; Edna Katz, M.D., and Somri Mustafa, M.D.; B'nai Zion Medical Center, 47 Golomb St., P.O. Box 4940, Haifa, 31048, Israel. France: Luc Noel, M.D., Etablissement de Transfusion Sanguine de Versailles, LeChesnay, France. Rachid Salmi, M.D., Ph.D.; and Charlotte Huet, M.D.; Université Victor Segalen Bordeaux II, Bordeaux, France. Denmark: Helga Sigmund, M.Sc., Danish Institute for Health Technology Assessment, National Board of Health, 13 Amaliegade, P.O. Box 2020, DK-1012 Copenhagen K, Denmark. Australia: Katherine McGrath, M.D., Department of Health, Hunter Area Health Service, Lookout Road, New Lambton, NSW 2305, Australia. Kim Henderson; David Henry, M.D.; and Carla Treloar; Faculty of Medicine, University of Newcastle, Newcastle, NSW 2308 Australia.