Project Details

Description

Existing literature suggests that there is institutional variation in
transfusion practices that may be related to the use of a
hemoglobin-based "transfusion trigger" at some institutions. Given the
known risks and costs of transfusions, the decision to transfuse should
be based on a careful consideration of the risks and benefits of the
procedure. However, little is known about the benefit (or lack of
benefit) of transfusions in different clinical settings, and this may be
one reason for the continued use of a hemoglobin-based "transfusion
trigger" by some surgeons and/or institutions. Therefore, the Division of General Internal Medicine, Robert Wood Johnson
Medical School proposes to perform a multi-center retrospective study to
1) describe the independent risk factors for perioperative transfusions
in patients with hip fracture. The aim of this analysis is to determine
whether the decision to transfuse is driven primarily by patient- and
procedure-related variables (e.g. age, co-morbid disease, blood loss) or
is significantly influenced by institutional practice styles independent
of patient and procedure characteristics, and 2) describe the effect of
transfusions on the operative death rate in patients with hip fracture by
comparison with similar patients not receiving transfusions. The study population will include 10,000 hip fracture patients who had
surgical repair of the fracture between 1983 and 1992. The population
will be drawn from hospitals located in one of four geographical
locations: Philadelphia, PA; New Brunswick, NJ; San Antonio, Texas and
Richmond, VA. Patient information will be obtained through a
retrospective review of medical records. In the first part of the study,
we will develop a logistic regression model to describe the independent
predictors of transfusion. In the second part of the study, we will
first describe the univariate relationship between transfusion status and
post-operative mortality stratified by hemoglobin level. We will then
use logistic regression control for the effects of important confounding
variables. This analysis will allow us to describe the independent
effect of transfusion on the risk of post-operative death at various
hemoglobin levels. Given that the risk of blood transfusions is
significant and the expense related to maintaining the blood supply is
enormous, new research is needed to define more sophisticated clinical
guidelines for transfusion that may improve patients' outcomes while
conserving the precious supply of blood. The proposed research, in
conjunction with the investigators earlier and ongoing studies of anemia
and surgery, will help to provide a cohesive picture of transfusion
practices. This information will serve as an important step in defining
and communicating more sophisticated transfusion guidelines.
StatusFinished
Effective start/end date4/1/935/31/96

Funding

  • National Institutes of Health
  • National Institutes of Health
  • National Institutes of Health

ASJC

  • Medicine(all)

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