Grant: Project Grant

Red blood cell transfusions are common in patients receiving gastrointestinal surgery, however, they often cause significant harm, including increased risk of death, cancer recurrence and longer hospital stays. There exists significant evidence that shows restricting transfusions improves patient outcomes, but still every second transfusion administered to gastrointestinal surgery patients is unnecessary and potentially avoidable. We propose to fill these gaps analyze transfusion practices with a focus on avoidable red blood cell transfusions, and develop quality indicators to identify institutional performance and quality assessment. This project has four objectives performed in a population of gastrointestinal cancer surgery patients. First we will examine variation in the use of all red blood cell transfusions between institutions, and identify factors associated with use of transfusions. Second, we will examine variation in the use of avoidable red blood cell transfusions between institutions, and identify factors associated with use of unnecessary transfusions. Third, we will examine variation in post-operative outcomes (30-day mortality, 90-day readmission, and overall survival) between institutions, and assess their association with red blood cell transfusions. Finally, in collaboration with patients, heath care providers, and policy-makers, we will identify consensus-based quality indicators for use of red blood cell transfusions that can be used to assess institutional quality of care and performance in gastrointestinal surgery. This project has the potential to minimize already scarce blood resources. Information on avoidable red blood cell transfusions and quality indicators for perioperative use of transfusions is needed to design interventions aimed at reducing variation via increased uptake of best practices.