Office of Blood, Organ, and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee.
Transfusion. 2019 Mar;59(3):1125-1131. doi: 10.1111/trf.15189. Epub 2019 Feb 10.
Estimates of blood collection and use in the United States derived from the National Blood Collection and Utilization Survey (NBCUS) call for application of robust statistical methods in the analysis of survey data. Since 1993, annual inpatient surgical volume has been used as the main stratification variable for sampling and estimation. However, recent NBCUS results have shown a decrease in blood use in surgical settings, raising the possibility that inpatient surgical volume may no longer be the optimal stratification variable. The objective of this study is to explore factors affecting hospital blood utilization.
A multivariate generalized linear regression with a negative binomial distribution was used to determine which hospital characteristics best explained allogeneic red blood cell (RBC) use, using data from the 2015 NBCUS to determine hospital blood use and the 2013 annual American Hospital Association database to identify hospital characteristics.
Annual inpatient surgical volume explained the most variation in allogeneic RBC use among hospitals (pseudo-R of 70.8%). Additional variables, such as presence of an oncology service, were also statistically significant in the models but explained little additional variability in blood use.
These findings suggest that annual inpatient surgical volume is an appropriate indicator for estimating blood utilization in the United States. As trends in blood utilization continue to evolve, ongoing analytic efforts to understand indicators of blood use are necessary.
根据美国国家血液采集和利用调查（NBCUS）的数据估计，美国的血液采集和使用量需要在分析调查数据时应用稳健的统计方法。自 1993 年以来，年度住院手术量一直被用作抽样和估计的主要分层变量。然而，最近 NBCUS 的结果显示，手术环境中的血液使用量有所下降，这增加了住院手术量可能不再是最佳分层变量的可能性。本研究旨在探讨影响医院血液利用的因素。
使用具有负二项分布的多变量广义线性回归来确定哪些医院特征能最好地解释异体红细胞（RBC）的使用情况，使用 2015 年 NBCUS 的数据来确定医院的血液使用情况，并使用 2013 年美国医院协会年度数据库来确定医院特征。
年度住院手术量解释了医院间异体 RBC 使用的最大变化（伪 R²为 70.8%）。模型中还存在其他变量，如肿瘤服务的存在，在统计学上也是显著的，但对血液使用的变化解释很少。
这些发现表明，年度住院手术量是估计美国血液利用的一个合适指标。随着血液利用趋势的不断发展，有必要进行持续的分析努力，以了解血液利用的指标。
