Factors associated with red blood cell, platelet, and plasma transfusions among inpatient hospitalizations: a nationally representative study in the United States

Ruchika Goel, Eshan U. Patel, Jodie L. White, Meera R. Chappidi, Paul Michael Ness, Melissa M. Cushing, Clifford M Takemoto, Beth H. Shaz, Steven Mark Frank, Aaron A Tobian

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalTransfusion
DOIs
StateAccepted/In press - Jan 1 2018

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Platelet Transfusion
Inpatients
Erythrocyte Transfusion
Hospitalization
Blood Platelets
Erythrocytes
Confidence Intervals
Urban Hospitals
Teaching Hospitals
Rural Hospitals
Demography
Weights and Measures

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Hematology

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Factors associated with red blood cell, platelet, and plasma transfusions among inpatient hospitalizations : a nationally representative study in the United States. / Goel, Ruchika; Patel, Eshan U.; White, Jodie L.; Chappidi, Meera R.; Ness, Paul Michael; Cushing, Melissa M.; Takemoto, Clifford M; Shaz, Beth H.; Frank, Steven Mark; Tobian, Aaron A.

In: Transfusion, 01.01.2018.

Research output: Contribution to journalArticle

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title = "Factors associated with red blood cell, platelet, and plasma transfusions among inpatient hospitalizations: a nationally representative study in the United States",
abstract = "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.",
author = "Ruchika Goel and Patel, {Eshan U.} and White, {Jodie L.} and Chappidi, {Meera R.} and Ness, {Paul Michael} and Cushing, {Melissa M.} and Takemoto, {Clifford M} and Shaz, {Beth H.} and Frank, {Steven Mark} and Tobian, {Aaron A}",
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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 Michael

AU - Cushing, Melissa M.

AU - Takemoto, Clifford M

AU - Shaz, Beth H.

AU - Frank, Steven Mark

AU - Tobian, Aaron A

PY - 2018/1/1

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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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