Inter‐hospital variation in use of obstetrical blood transfusion: a population‐based cohort study

• Published in: BJOG : an international journal of obstetrics and gynaecology Vol. 127; no. 11; pp. 1392 - 1398
• Main Authors: Hutcheon, JA, Chapinal, N, Skoll, A, Au, N, Lee, L
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.10.2020
• Subjects: Blood; Blood transfusion; Blood transfusions; clinical practice variation; Cohort analysis; Erythrocytes; Gestation; hospital comparisons; Hospitals; Patients; Population studies; Population-based studies; Pregnancy; Regression analysis; Risk factors; severe maternal morbidity; Variation; British Columbia Canada; Canada; hospital comparisons; severe maternal morbidity; clinical practice variation; Blood transfusion; pregnancy
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/1471-0528.16203

Objective To identify the extent of hospital‐to‐hospital variation in use of obstetrical blood transfusion. Design Population‐based cohort study linking provincial perinatal and blood transfusion registries. Setting British Columbia, Canada, 2004–2015. Population All pregnant women delivering at or beyond 20 weeks’ gestation at any British Columbia hospital. Methods Mixed‐effects regression models were used to estimate hospital‐specific transfusion rates after sequentially accounting for (1) the role of random variation, (2) maternal medical and obstetrical characteristics (i.e. patient case mix) and (3) institutional and delivery factors (such as use of instrumental or caesarean delivery). Main outcome measures Hospital‐specific use of obstetrical red blood cell transfusion. Results Among 44 hospitals, crude institutional transfusion rates across the study period ranged from 3.7 to 23.6 per 1000, with an average of 8.3 per 1000. After adjusting for maternal characteristics, institution and delivery risk factors, a nearly three‐fold difference in rates between the 10th and 90th percentile remained (5.4–14.5 per 1000). Twelve sites had rates significantly higher or lower than the provincial average. Women residing in remote areas were 2.5‐fold (95% CI 1.8–3.5] more likely to receive a blood transfusion than were women residing in metropolitan areas. Conclusions Meaningful variation between hospitals in use of blood transfusion during pregnancy was not explained by differences in patient case‐mix or institutional factors, suggesting that over‐ or under‐utilisation of this resource may be occurring in obstetrical care. Tweetable Use of blood transfusion in pregnant women varied broadly between hospitals in British Columbia, Canada. Tweetable Use of blood transfusion in pregnant women varied broadly between hospitals in British Columbia, Canada.