United BioSource Corporation (UBC), Lexington, Massachusetts, United States of America.
Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
Blood Transfus. 2014 Jan;12 Suppl 1(Suppl 1):s90-9. doi: 10.2450/2013.0170-12. Epub 2013 Feb 6.
Blood transfusion occurring during hospitalisation for heart surgery has been shown to be associated with increased morbidity and mortality and with increased time spent in hospital, use of healthcare services, and costs. The objective of this study was to assess how perioperative blood transfusion among adults 65 years and older who underwent coronary artery bypass graft surgery requiring cardiopulmonary bypass in the United States is associated with immediate and longer term clinical and economic outcomes.
Using data from a 5% random sample of Medicare patients who underwent their first (within 2 years) coronary artery bypass graft requiring cardiopulmonary bypass procedure in 2005 or 2006, this study estimated associations (hazard ratios and regression coefficients) between transfusion status (received or not) and complications after surgery, serious adverse events, death, and costs using Cox proportional hazard and generalised linear models adjusting for patients' demographic and clinical characteristics.
Adjusted hazard ratios were statistically significant (P<0.05) for risks of complications (1.20), serious adverse events (1.58), and death (1.49). There was also a statistically significantly (P≤0.01) and strong relationship between receiving transfused blood and Medicare payments over the subsequent 45 months following discharge ($5,778 per calendar quarter for those receiving transfusion vs $5,197; all costs are measured in 2011 USD).
Blood transfusion during hospitalisation for coronary artery bypass graft requiring cardiopulmonary bypass was significantly associated with increased long-term post-operative morbidity, mortality, and overall healthcare costs. This study contributes to the evidence demonstrating an association between transfusion and adverse clinical and economic outcomes by using a nationally representative longitudinal cost and utilisation database.
心脏手术住院期间输血与发病率和死亡率增加以及住院时间延长、医疗保健服务使用增加和成本增加有关。本研究的目的是评估美国在体外循环下接受冠状动脉旁路移植术的 65 岁及以上成年人围手术期输血与近期和长期临床及经济结果的关系。
本研究使用了 Medicare 患者 5%随机样本的数据，这些患者在 2005 年或 2006 年接受了第一次（在 2 年内）需要体外循环的冠状动脉旁路移植术，使用 Cox 比例风险和广义线性模型估计了输血状态（输血或未输血）与术后并发症、严重不良事件、死亡和成本之间的关联（风险比和回归系数），调整了患者的人口统计学和临床特征。
调整后的风险比在统计学上有显著差异（P<0.05），分别为并发症（1.20）、严重不良事件（1.58）和死亡（1.49）的风险。输血与 Medicare 在出院后 45 个月内的支付之间也存在统计学上显著（P≤0.01）和强关系（输血者每日历季度支付 5778 美元，而非输血者支付 5197 美元；所有成本均以 2011 年美元衡量）。
体外循环下冠状动脉旁路移植术住院期间输血与长期术后发病率、死亡率和整体医疗保健成本增加显著相关。本研究通过使用全国代表性的纵向成本和利用数据库，为输血与不良临床和经济结果之间的关系提供了证据。
