{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T09:58:57Z","timestamp":1787133537578,"version":"build-2736575974"},"reference-count":29,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2014,11,2]],"date-time":"2014-11-02T00:00:00Z","timestamp":1414886400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Transfusion"],"published-print":{"date-parts":[[2015,4]]},"abstract":"Background<\/jats:title>We sought to determine whether publication of blood conservation guidelines by the S<\/jats:styled-content>ociety of T<\/jats:styled-content>horacic S<\/jats:styled-content>urgeons in 2007 influenced transfusion rates and to understand how patient\u2010 and hospital\u2010level factors influenced blood product usage.<\/jats:p><\/jats:sec>Study Design and Methods<\/jats:title>We identified 4,465,016 patients in the N<\/jats:styled-content>ationwide I<\/jats:styled-content>npatient S<\/jats:styled-content>ample database who underwent cardiac operations between 1999 and 2010 (3,202,404 before the guidelines and 1,262,612 after). Hierarchical linear modeling was used to account for hospital\u2010 and patient\u2010level clustering.<\/jats:p><\/jats:sec>Results<\/jats:title>Transfusion rates of blood products increased from 13% in 1999 to a peak of 34% in 2010. Use of all blood components increased over the study period. Aortic aneurysm repair had the highest transfusion rate with 54% of patients receiving products in 2010. In coronary artery bypass grafting, the number of patients receiving blood products increased from 12% in 1999 to 32% in 2010. Patients undergoing valvular operations had a transfusion rate of 15% in 1999, increasing to 36% in 2010. Patients undergoing combined operations had an increase from 13% to 40% over 11 years. Risk factors for transfusion were anemia (odds ratio [OR<\/jats:styled-content>], 2.05; 95% confidence interval [CI<\/jats:styled-content>], 2.01\u20102.09), coagulopathy (OR<\/jats:styled-content>, 1.54; 95% CI<\/jats:styled-content>, 1.51\u20101.57), diabetes (OR<\/jats:styled-content>, 1.32; 95% CI<\/jats:styled-content>, 1.28\u20101.36), renal failure (OR<\/jats:styled-content>, 1.29; 95% CI<\/jats:styled-content>, 1.26\u20101.32), and liver disease (OR<\/jats:styled-content>, 1.23; 95% CI<\/jats:styled-content>, 1.16\u20101.31). Compared to the N<\/jats:styled-content>ortheast, the risk for transfusion was significantly lower in the M<\/jats:styled-content>idwest; higher\u2010volume hospitals used fewer blood products than lower\u2010volume centers. Cell salvage usage remained below 5% across all years.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>Independent of patient\u2010 and hospital\u2010level factors, blood product utilization continues to increase for all cardiac operations despite publication of blood conservation guidelines in 2007.<\/jats:p><\/jats:sec>","DOI":"10.1111\/trf.12903","type":"journal-article","created":{"date-parts":[[2014,11,3]],"date-time":"2014-11-03T04:06:31Z","timestamp":1414987591000},"page":"805-814","source":"Crossref","is-referenced-by-count":74,"title":["Trends in blood utilization in U<\/scp>nited S<\/scp>tates cardiac surgical patients"],"prefix":"10.1111","volume":"55","author":[{"given":"Michael P.","family":"Robich","sequence":"first","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery Heart and Vascular Institute Cleveland Clinic Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colleen G.","family":"Koch","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Anesthesia Cleveland Clinic Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas R.","family":"Johnston","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery Heart and Vascular Institute Cleveland Clinic Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Schiltz","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics Case Western Reserve University Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aiswarya","family":"Chandran Pillai","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics Case Western Reserve University Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed T.","family":"Hussain","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery Heart and Vascular Institute Cleveland Clinic Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward G.","family":"Soltesz","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery Heart and Vascular Institute Cleveland Clinic Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,11,2]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1537-2995.2007.01128.x"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.1406"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000217920.48559.D8"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-013-3020-y"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa070403"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2007.06.025"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2007.02.099"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2010.11.078"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1213\/ane.0b013e3181aa084c"},{"key":"e_1_2_7_11_1","unstructured":"Healthcare Cost and Utilization Project (HCUP).Clinical Classifications Software (CCS) for ICD\u20109\u2010CM. 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