Evaluating Variation in Red Blood Cell Transfusion for Patients Undergoing Elective Gastrointestinal Cancer Surgery

• Main Author: Zuckerman, Jesse
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01-01-2021
• Subjects: Epidemiology; Health care management; Oncology; Surgery
• ISBN: 9798496549769

Understanding variation in transfusion practice among patients undergoing gastrointestinal cancer surgery will support efforts working towards responsible transfusion use. We performed a population-based study of patients who underwent elective gastrointestinal cancer resection between 2007 and 2019 to measure variation in transfusion use across surgeons and hospitals. Variation was explored using funnel plots and multilevel regression. Of 59,964 patients, 18.0% were transfused. Wide variation in transfusion use among surgeons and hospitals was observed. Patient characteristics explained 12.8% of the variation. After adjusting for patient case-mix, between-surgeon and between-hospital differences were responsible for 2.8% and 2.1% of the variation, respectively, translating to an approximately 30% difference in the odds of transfusion for two similar patients treated by distinct surgeons or hospitals, respectively. Although transfusion provision depends on patient factors, important variation across surgeons and hospitals creates opportunities to target modifiable processes of care to standardize perioperative transfusion practice.