Blood transfusion linked to infection; transfusion practices varied among Michigan hospitals

Thirty percent of transfusion variation in patients who underwent coronary artery bypass graft from 2003 to 2006 and received allogeneic blood transfusions was due to the hospital site.

Data from fee-for-service Medicare beneficiaries (n=24,789) who were Michigan residents or who received surgery in a Michigan hospital were examined. Researchers from the University of Michigan analyzed differences in transfusion use and infection rates in hospitals, and the relationship between transfusion and patient outcomes.

Overall, the hospital site was responsible for 29.95% (95% CI, 20.45-41.55) variance in allogeneic transfusion practices. During hospitalization, infection was observed in 16.2% of patients.

Allogeneic blood transfusion increased the odds for in-hospital infection twofold (OR=1.98; 95% CI, 1.59-2.46) and in-hospital mortality almost fivefold (OR=4.67; 95% CI, 2.38-9.18). The odds were also increased for 30-day re-admission to the hospital (OR=1.43; 95% CI, 1.25-1.65) and 30-day post-discharge mortality (OR=2.88; 95% CI, 1.38-5.98).

Allogeneic transfusion was linked to increased infections of the genitourinary system (P=.023), respiratory tract (P<.001), circulatory system (P=.093), digestive tract (P=.048) and skin (P<.001). Increases in sepsis (P<.001) and infection with Clostridium difficile (P=.008) were observed as well.

“The safety of patients undergoing CABG will likely be improved if hospitals carefully review current guidelines on allogeneic blood transfusion, closely adhere to such guidelines and institute interventions to reduce inappropriate use of blood transfusions in recipients of CABG,” the researchers said.

Rogers MAM. BMC Med. 2009;doi:10.1186/1741-7015-7-37.

There have been a number of publications suggesting an increase in infectious complications associated with allogeneic blood transfusion and cardiac surgery and the amount of blood transfused specifically. This issue has been debated in other studies as well. This article supports the notion that there may well be adverse transfusion-induced effects associated with increased infectious complications in patients undergoing cardiac surgery. However, these data are, once again, not conclusive but are interesting in that they also highlight hospital(local )variations in transfusion practice that appear to be another contributing variable.

– Ronald A. Sacher, MD

HemOnc Today Editorial Board member