Comparative changes of pre-operative autologous transfusions and peri-operative cell salvage in the United States.

Publisher: American Association Of Blood Banks Country of Publication: United States NLM ID: 0417360 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1537-2995 (Electronic) Linking ISSN: 00411132 NLM ISO Abbreviation: Transfusion Subsets: MEDLINE

Original Publication: Arlington, Va. : American Association Of Blood Banks

Blood Transfusion, Autologous* ; Databases, Factual* ; Erythrocyte Transfusion* ; Hospitalization* ; Operative Blood Salvage*; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; United States

Background: With improved safety of allogeneic blood supply, the use of preoperative autologous donations (PADs) and perioperative autologous cell salvage (PACS) has evolved. This study evaluated temporal trends in PAD and PACS use in the United States.
Methods: The National Inpatient Sample database, a stratified probability sample of 20% of hospitalizations in the United States, was used to compare temporal trends in hospitalizations reporting use of PADs and PACS from 1995 to 2015. Factors associated with their use were examined between 2012 and 2015 with use of multivariable Poisson regression. Sampling weights were applied to generate nationally representative estimates.
Results: There was a steady decrease in hospitalizations reporting PAD transfusions from 27.90 per 100 000 in 1995 to 1.48 per 100 000 hospitalizations in 2015 (P-trend <.001). In contrast, PACS increased from a rate of 1.16 per 100 000 in 1995 to peak of 20.51 per 100 000 hospitalizations in 2008 and then steadily declined (P-trend<.001). Higher odds of PACS and PADs were observed in older patients, elective procedures (vs urgent), and urban teaching/nonteaching hospitals (vs rural hospitals) (P < .001). PACS was more common in hospitalizations in patients with higher levels of severity of illness as compared to those with minor severity (adjusted prevalence ratio [adjPR], 2.39; 95% confidence interval [CI], 2.08-2.73; P<.001), while PADs were performed less often in patients with higher underlying severity of illness (All Patient Refined Diagnosis Related Groups, 4 vs 1, adjPR, 0.61; 95% CI, [0.39-0.95]; P = .028).
Conclusions: There was a significant decrease in PAD red blood cell transfusions, while PACS has increased and subsequently decreased; PACS plays an important role in surgical blood conservation. The subsequent decline in PACS likely reflects further optimization of transfusion practice through patient blood management programs and improvement of surgical interventions.
(© 2020 AABB.)

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R01AI128779 National Institute of Allergy and Infectious Diseases; R01 AI120938 United States AI NIAID NIH HHS; T32AI102623 National Institute of Allergy and Infectious Diseases; K23HL151826 United States HL NHLBI NIH HHS; R01 AI128779 United States AI NIAID NIH HHS; T32 AI102623 United States AI NIAID NIH HHS; R01AI120938 National Institute of Allergy and Infectious Diseases; K23 HL151826 United States HL NHLBI NIH HHS

Date Created: 20200902 Date Completed: 20210629 Latest Revision: 20240807

20240807

PMC7902373

10.1111/trf.15949

32869327