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Observational Study
. 2020 Oct;60(10):2260-2271.
doi: 10.1111/trf.15949. Epub 2020 Aug 31.

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

Ruchika Goel  1   2   3 , Molly R Petersen  1 , Eshan U Patel  1 , Zoe Packman  1 , Evan M Bloch  1 , Eric A Gehrie  1 , Parvez M Lokhandwala  1 , Paul M Ness  1 , Beth Shaz  4 , Louis M Katz  2 , Steven M Frank  5 , Aaron A R Tobian  1
Affiliations
Observational Study

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

Ruchika Goel et al. Transfusion. 2020 Oct.

Erratum in

Abstract

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.

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Conflict of interest statement

Conflict of Interest Disclosures: The authors do not have conflicts of interest.

Figures

Figure 1:
Figure 1:
Trends in the transfusion of perioperative cell salvage and autologous transfusions from 1995 to 2015 (through the third quarter of 2015) in the National Inpatient Sample. The p-trend has been calculated from year 2012 through 3rd Quarter of 2015.
See this image and copyright information in PMC

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