Technologies to minimize blood transfusion in cardiac and orthopedic surgery: Results of a practice variation survey in nine countries

Dean A. Fergusson, Angela Blair, David Henry, Akinori Hisashige, Charlotte Huet, Ankie Koopman-Van Gemert, Edna Katz, Brian McClelland, Helga Sigmund, Andreas Laupacis

Research output: Contribution to journalReview articleResearchpeer-review

35 Citations (Scopus)

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 homodilution 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.

Original languageEnglish
Pages (from-to)717-728
Number of pages12
JournalInternational Journal of Technology Assessment in Health Care
Volume15
Issue number4
Publication statusPublished - Sep 1999
Externally publishedYes

Fingerprint

Blood Transfusion
Thoracic Surgery
Orthopedics
Technology
Tranexamic Acid
Aprotinin
Pharmaceutical Preparations
Aminocaproic Acid
Hemodilution
Erythropoietin
Surveys and Questionnaires
HIV
Equipment and Supplies

Cite this

Fergusson, Dean A. ; Blair, Angela ; Henry, David ; Hisashige, Akinori ; Huet, Charlotte ; Koopman-Van Gemert, Ankie ; Katz, Edna ; McClelland, Brian ; Sigmund, Helga ; Laupacis, Andreas. / Technologies to minimize blood transfusion in cardiac and orthopedic surgery : Results of a practice variation survey in nine countries. In: International Journal of Technology Assessment in Health Care. 1999 ; Vol. 15, No. 4. pp. 717-728.
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title = "Technologies to minimize blood transfusion in cardiac and orthopedic surgery: Results of a practice variation survey in nine countries",
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 homodilution 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.",
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Fergusson, DA, Blair, A, Henry, D, Hisashige, A, Huet, C, Koopman-Van Gemert, A, Katz, E, McClelland, B, Sigmund, H & Laupacis, A 1999, 'Technologies to minimize blood transfusion in cardiac and orthopedic surgery: Results of a practice variation survey in nine countries' International Journal of Technology Assessment in Health Care, vol. 15, no. 4, pp. 717-728.

Technologies to minimize blood transfusion in cardiac and orthopedic surgery : Results of a practice variation survey in nine countries. / Fergusson, Dean A.; Blair, Angela; Henry, David; Hisashige, Akinori; Huet, Charlotte; Koopman-Van Gemert, Ankie; Katz, Edna; McClelland, Brian; Sigmund, Helga; Laupacis, Andreas.

In: International Journal of Technology Assessment in Health Care, Vol. 15, No. 4, 09.1999, p. 717-728.

Research output: Contribution to journalReview articleResearchpeer-review

TY - JOUR

T1 - Technologies to minimize blood transfusion in cardiac and orthopedic surgery

T2 - Results of a practice variation survey in nine countries

AU - Fergusson, Dean A.

AU - Blair, Angela

AU - Henry, David

AU - Hisashige, Akinori

AU - Huet, Charlotte

AU - Koopman-Van Gemert, Ankie

AU - Katz, Edna

AU - McClelland, Brian

AU - Sigmund, Helga

AU - Laupacis, Andreas

PY - 1999/9

Y1 - 1999/9

N2 - 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 homodilution 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.

AB - 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 homodilution 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.

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VL - 15

SP - 717

EP - 728

JO - International Journal of Technology Assessment in Health Care

JF - International Journal of Technology Assessment in Health Care

SN - 0266-4623

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