A new study suggests that blood transfusions for hospitalized cardiac patients should be a last resort because they double the risk of infection and increase by four times the risk of death.
The analysis of nearly 25,000 Medicare patients in Michigan also showed that transfusion practices after heart surgery varied substantially among hospitals, a red flag that plays into the health care reform debate.
A wide variation in care is a hot-button issue, as lawmakers and health reform experts discuss the best ways to address the variations. Some experts believe the country needs a system of medical guidelines, supported by scientific evidence, to aid doctors in decision-making. In fact, the Institute of Medicine has called for a national initiative of comparing the benefits and harms of certain methods to improve the delivery of care -- an effort referred to by health-care insiders as "comparative effectiveness" research.
Blood transfusion is an area that could be well served with stronger, research-based guidelines, since the current clinical practice is all over the map, said study co-author Neil Blumberg, M.D., professor of Pathology and Laboratory Medicine and director of Transfusion Medicine at the University of Rochester Medical Center.
"Doctors are simply doing what they were trained to do, but it turns out that their actions are more harmful than helpful in many cases," Blumberg said. "This is an instance in which clinical practice got way ahead of research. And changing the liberal use of transfusions is going to be difficult despite the evidence showing it is usually not essential."
The study was published July 31, 2009 in the journal, BMC Medicine. It was designed to assess patient outcomes as well as hospital variation in blood use.
Blumberg and lead author Mary Rogers, Ph.D., of the University of Michigan Health System, analyzed patient records in 40 hospitals, from admission to 30 days af
|Contact: Karin Christensen|
University of Rochester Medical Center