Background: Small transfusions (1-2 units) of red blood cells (RBCs) have been associated with significantly increased odds of morbidity and mortality in the setting of cardiac surgery. Despite the development of blood management guidelines, provider-level variability persists in RBC transfusion practice. We hypothesize that a provider’s beliefs concerning the risk and safety of transfusions may influence his/her threshold for transfusing a patient.
Study Design and Methods: We surveyed operating room transfusion decision-makers (anesthesiologists, perfusionists, surgeons) across all 33 non-federal cardiac surgery programs in the state of Michigan. Survey questions assessed a respondent’s hematocrit threshold (“trigger”), as well as belief concerning the perceived risk and safety of transfusions (on a 5-point Likert Scale). Linear regression models were used to estimate the independent effect of a provider’s beliefs on the inclination to transfuse.
Results: One hundred and eighty-six of 413 submitted surveys were returned (45% response rate). Differences existed across providers in their belief concerning: (1) the risk of anemia (p < 0.01, table 1), and (2) transfusion safety (p = 0.02, table 1). Higher transfusion triggers were associated with a respondent’s: (1) concern for the risk of anemia (difference: 0.61, p < 0.01), and (2) belief in the safety of transfusions (difference: 0.41, p = 0.04). Perceived risks of complications (e.g., transfusion reactions, acute kidney injury) associated with transfusions differed across provider types (all p < 0.01).
Conclusion: A provider’s belief in the safety of transfusions and concern for the risk of anemia was significantly associated with a greater likelihood of blood utilization. Our findings suggest that future blood management interventions should address a provider’s beliefs concerning blood transfusions.