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Blood Transfusion After Coronary Artery Bypass Graft Surgery

Barry Dixon, MD, PhD; John D. Santamaria, MD
JAMA. 2011;305(2):149-150. doi:10.1001/jama.2010.1956.
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To the Editor: Dr Bennett-Guerrero and colleagues1 observed a marked variation among hospitals in the use of blood transfusion following coronary artery bypass graft (CABG) surgery. The authors considered inconsistency in transfusion practices as a possible explanation for these differences. However, another important factor may have been variation in the extent of bleeding.

The extent of chest tube bleeding varies among patients and is correlated with red cell transfusion.2 Previous studies and meta-analysis have demonstrated marked variations in the extent of bleeding among surgeons undertaking similar cases.2,3 Moreover, the Sixth Report of the National Adult Cardiac Surgery Database for Great Britain and Ireland also found wide variation among centers in the extent of bleeding complications requiring re-operation (0.5% to 6%).4 We believe much of the unexplained variation found in this study may be due to differences in bleeding. Changes in surgical practices to minimize bleeding may provide another approach to reduce the need for blood transfusion.5


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January 12, 2011
Elliott Bennett-Guerrero, MD; T. B. Ferguson, MD; Howard K. Song, MD, PhD
JAMA. 2011;305(2):149-150. doi:10.1001/jama.2010.1957.
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