Sterile Gauzes and Latent Causes: Inside the Black Box of Transfusion in CABG Patients

Abstract

Proponents of tort reform argue that liability concerns drive physicians to overutilize medical services. There is abundant research within the transfusion medicine community showing that significant variation in transfusion practice exists for the patients undergoing coronary artery bypass grafts, and that at least some transfusions administered are likely unnecessary. It is believed by many in the transfusion medicine community that these transfusions are an example of defensive medicine. Using National Inpatient Sample of the Healthcare Cost and Utilization Project, I evaluate pre- and posttort reform samples of cardiac patients in states enacting direct reforms (new limits on non-economic damage awards). Pre- and posttort reform samples show a significant increase in the risk profile of the patient population. This endogeneity is controlled via Coarsened Exact Matching (CEM). Within the CEM sample, there is no statistically significant impact of tort reform on an individual cardiac patient's probability of being transfused. However, it is possible that the shift in risk profile of the CABG patient population is a result of tort reform, and that hospitals in states enacting such reforms will unexpectedly consume more resources to compensate for this increase in risk.