Frequency and Outcomes of Blood Products Transfusion Across Procedures and Clinical Conditions Warranting Inpatient Care: An Analysis of the 2004 Healthcare Cost and Utilization Project Nationwide Inpatient Sample Database

Abstract

The objective of this retrospective cohort study was to assess frequency and outcomes associated with blood products transfusion. Data from the 2004 Nationwide Inpatient Sample database were used. Length of stay (LOS), postoperative infections, noninfectious transfusion-related complications, in-hospital mortality, and total charges were evaluated for transfused and nontransfused cohorts. Of the estimated 38.66 million discharges in the United States in 2004, 5.8% (2.33 million) were associated with blood products transfusion. Average LOS was 2.5 days longer, and charges were $17 194 higher for the transfused cohort (P < .0001). Odds of death were 1.7 times higher (P < .0001) and odds of infection 1.9 times higher (P < .0001) for the transfused cohort. Increased provider awareness and recognition of the frequency and potential negative outcomes of blood products transfusion may encourage the adoption of novel approaches to minimize intraoperative and early postoperative bleeding, reduce transfusion requirements, and most important, improve patient-level postoperative outcomes and health-related quality of life.

Keywords

transfusion frequency outcomes NIS retrospective

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References

Whitaker BI , Sullivan M. The 2005 Nationwide Blood Collection and Utilization Survey Report. Bethesda, MD: AABB; 2006.

Spahn DR Strategies for transfusion therapy. Best Pract Res Clin Anaesthesiol . 2004;8:661-673.

New York State Council on Human Blood and Transfusion Services. Guidelines for Monitoring Transfusion Recipients . 2nd ed. Albany, NY: New York State Department of Health; 2004.

Mannucci PM , Levi M. Prevention and treatment of major blood loss. N Engl J Med . 2007;365:2301-2311.

Marietta M. , Facchini L. , Pedrazzi P. , et al. Pathophysiology of bleeding in surgery. Transplant Proc. 2006;38:812-814.

Perrotta PL , Snyder EL Non-infectious complications of transfusion therapy. Blood Rev. 2001;15:69-83.

Koch CG , Khandwala F. , Li L. , Estafanous FG , Loop FD , Blackstone EH Persistent effect of red cell transfusion on health-related quality of life after cardiac surgery. Ann Thorac Surg. 2006 ;82:13-20.

Engoren MC , Habib RH , Zacharias A. , Schwann TA , Riordan CJ , Durham SJ Effect of blood transfusion on long-term survival after cardiac operation . Ann Thorac Surg. 2002;74:1180-1186.

Steinitz D. , Harvey EJ , Leighton RK , Petri DP Is homologous blood transfusion a risk factor for infection after hip replacement ? Can J Surg. 2001;44:355-358.

10.

Banbury MK , Brizzio ME , Rajeswaran J. , Lytle BW , Blackstone EH Transfusion increases the risk of postoperative infection after cardiovascular surgery. J Am Coll Surg. 2006;202:131-138.

11.

Surgenor SD , DeFoe GR , Fillinger MP , et al. Intraoperative red blood cell transfusion during coronary artery bypass graft surgery increases the risk of postoperative low-output heart failure. Circulation. 2006 ;114(1 suppl):143-148.

12.

Kuduvalli M. , Oo AY , Newall N. , et al. Effect of peri-operative red blood cell transfusion on 30-day and 1-year mortality following coronary artery bypass surgery. Eur J Cardiothorac Surg. 2005 ;27:592-598.

13.

Carson JL , Altman DG , Duff A. , et al. Risk of bacterial infection associated with allogenic blood transfusion among patients undergoing hip fracture repair. Transfusion. 1999; 39:694-700.

14.

Everts PA , Devilee RJ , Brown Mahoney C. , et al. Platelet gel and fibrin sealant reduce allogeneic blood transfusions in total knee arthroplasty. Acta Anaesthesiol Scand. 2006; 50:593-599.

15.

Sitges-Serra A. , Sancho Insenser JJ , Membrilla E. Blood transfusions and postoperative infections in patients undergoing elective surgery. Surg Infect. 2006;7(suppl 2):S33-S35.

16.

Huber-Wagner S. , Qvick M. , Mussack T. , et al. Massive blood transfusion and outcome in 1062 polytrauma patients: a prospective study based on the Trauma Registry of the German Trauma Society. Vox Sang. 2007 ;92:69-78.

17.

Vamvakas EC , Carven JH , Hibberd PL Blood transfusion and infection after colorectal cancer surgery. Transfusion. 1996;36:1000-1008.

18.

Healthcare Cost and Utilization Project (HCUP). Overview of the Nationwide Inpatient Sample (NIS). http://www.hcupus.ahrq.gov/nisoverview.jsp. Accessed October 18, 2007.

19.

Healthcare Cost and Utilization Project (HCUP). Clinical Classifications Software (CCS) for ICD-9-CM. http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp. Accessed October 18, 2007.

20.

Charlson ME , Pompei P. , Ales KL , MacKenzie CR A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373-383.

21.

Deyo RA , Cherkin DC , Ciol MA Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613-619.

22.

Houchens R. , Elixhauser A. Final report on calculating Nationwide Inpatient Sample (NIS) variances. http://www.hcup-us.ahrq.gov/reports/CalculatingNISVariances200106092005.pdf. Accessed October 18, 2007.

23.

Anderson SA , Menis M. , O’Connell K. , Burwen DR Blood use by inpatient elderly population in the United States. Transfusion. 2007;47:582-592.

24.

Vamvakas EC , Taswell HF Epidemiology of blood transfusion. Transfusion. 1994;34:464-470.

25.

Shulman IA , Saxena S. The transfusion services committee: responsibilities and response to adverse transfusion events. Hematology Am Soc Hematol Educ Program . 2005:483-490.