TY - JOUR
T1 - Factors associated with red blood cell, platelet, and plasma transfusions among inpatient hospitalizations
T2 - a nationally representative study in the United States
AU - Goel, Ruchika
AU - Patel, Eshan U.
AU - White, Jodie L.
AU - Chappidi, Meera R.
AU - Ness, Paul M.
AU - Cushing, Melissa M.
AU - Takemoto, Clifford M.
AU - Shaz, Beth H.
AU - Frank, Steven M.
AU - Tobian, Aaron A.R.
N1 - Publisher Copyright:
© 2018 AABB
PY - 2019/2
Y1 - 2019/2
N2 - BACKGROUND: Demographic and hospital-level factors associated with red blood cell (RBC), plasma, and platelet transfusions in hospitalized patients across the U.S. are not well characterized. METHODS: We conducted a retrospective analysis of the National Inpatient Sample (2014). The unit of analysis was a hospitalization; sampling weights were applied to generate nationally-representative estimates. The primary outcome was having ≥ 1 RBC transfusion procedure; plasma and platelet transfusions were similarly assessed as secondary outcomes. For each component, factors associated with transfusion were measured using adjusted prevalence ratios (adjPR) and 95% confidence intervals (95% CI) estimated by multivariable Poisson regression. RESULTS: The prevalence of RBC, plasma, and platelet transfusion was 5.8%, 0.9%, and 0.7%, respectively. RBC transfusions were associated with older age (≥ 65 vs. < 18 years; adjPR = 1.80; 95% CI = 1.66–1.96), female sex (adjPR = 1.13; 95% CI = 1.12–1.14), minority race/ethnic status, and hospitalizations in rural hospitals compared to urban teaching hospitals. Prevalence of RBC transfusion was lower among hospitalizations in the Midwest compared to the Northeast (adjPR = 0.73; 95% CI = 0.67–0.80). All components were more likely to be transfused in patients with a primary hematologic diagnosis, patients with a higher number of total diagnoses, patients who experienced a higher number of other procedures, and patients who eventually died in the hospital. In contrast to RBC transfusions, prevalence of platelet transfusion was greater in urban teaching hospitals (vs. rural; adjPR = 1.71; 95% CI = 1.49–1.98) and lower in blacks (vs. whites; adjPR = 0.80; 95% CI = 0.76–0.85). CONCLUSIONS: Nationally, there is heterogeneity in factors associated with transfusion between each blood component, including by hospital type and location. This variability presents patient blood management programs with potential opportunities to reduce transfusions.
AB - BACKGROUND: Demographic and hospital-level factors associated with red blood cell (RBC), plasma, and platelet transfusions in hospitalized patients across the U.S. are not well characterized. METHODS: We conducted a retrospective analysis of the National Inpatient Sample (2014). The unit of analysis was a hospitalization; sampling weights were applied to generate nationally-representative estimates. The primary outcome was having ≥ 1 RBC transfusion procedure; plasma and platelet transfusions were similarly assessed as secondary outcomes. For each component, factors associated with transfusion were measured using adjusted prevalence ratios (adjPR) and 95% confidence intervals (95% CI) estimated by multivariable Poisson regression. RESULTS: The prevalence of RBC, plasma, and platelet transfusion was 5.8%, 0.9%, and 0.7%, respectively. RBC transfusions were associated with older age (≥ 65 vs. < 18 years; adjPR = 1.80; 95% CI = 1.66–1.96), female sex (adjPR = 1.13; 95% CI = 1.12–1.14), minority race/ethnic status, and hospitalizations in rural hospitals compared to urban teaching hospitals. Prevalence of RBC transfusion was lower among hospitalizations in the Midwest compared to the Northeast (adjPR = 0.73; 95% CI = 0.67–0.80). All components were more likely to be transfused in patients with a primary hematologic diagnosis, patients with a higher number of total diagnoses, patients who experienced a higher number of other procedures, and patients who eventually died in the hospital. In contrast to RBC transfusions, prevalence of platelet transfusion was greater in urban teaching hospitals (vs. rural; adjPR = 1.71; 95% CI = 1.49–1.98) and lower in blacks (vs. whites; adjPR = 0.80; 95% CI = 0.76–0.85). CONCLUSIONS: Nationally, there is heterogeneity in factors associated with transfusion between each blood component, including by hospital type and location. This variability presents patient blood management programs with potential opportunities to reduce transfusions.
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U2 - 10.1111/trf.15088
DO - 10.1111/trf.15088
M3 - Article
C2 - 30548491
AN - SCOPUS:85058422021
SN - 0041-1132
VL - 59
SP - 500
EP - 507
JO - Transfusion
JF - Transfusion
IS - 2
ER -