title: Clinical and economic outcomes associated with blood transfusions among elderly Americans following coronary artery bypass graft surgery requiring cardiopulmonary bypass.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors: United BioSource Corporation (UBC), Lexington, Massachusetts, United States of America.
authors: Michael Lee
authors: ML
authors: Ganz
authors: United BioSource Corporation (UBC), Lexington, Massachusetts, United States of America.
authors: Ning
authors: N
authors: Wu
authors: Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
authors: James
authors: J
authors: Rawn
authors: United BioSource Corporation (UBC), Lexington, Massachusetts, United States of America.
authors: Chris Leo
authors: CL
authors: Pashos
authors: Novo Nordisk A/S, Søborg, Denmark.
authors: Martin
authors: M
authors: Strandberg-Larsen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000453:epidemiology / Q000628:therapy; D001803:Blood Transfusion / Q000191:economics / Q000706:statistics & numerical data*; D002315:Cardiopulmonary Bypass; D015897:Comorbidity; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000453:epidemiology / Q000601:surgery; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics; D038801:International Classification of Diseases; D016014:Linear Models; D008297:Male; D006278:Medicare / Q000191:economics; D019990:Perioperative Care / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012494:Sampling Studies; D012959:Socioeconomic Factors; D065227:Transfusion Reaction; D016896:Treatment Outcome; D014481:United States
references: Vital Health Stat 13. 2006 Oct;(162):1-209
references: 17091747
references: Infect Control Hosp Epidemiol. 2003 Jan;24(1):44-50
references: 12558235
references: J Health Econ. 2001 Jul;20(4):461-94
references: 11469231
references: Ann Thorac Surg. 2006 Nov;82(5):1747-56
references: 17062241
references: JAMA. 2010 Oct 13;304(14):1559-67
references: 20940381
references: N Engl J Med. 1997 May 22;336(21):1500-5
references: 9154770
references: Transfusion. 2011 Apr;51(4):894-900
references: 21496052
references: Ann Thorac Surg. 2006 May;81(5):1650-7
references: 16631651
references: J Am Coll Cardiol. 2009 Jun 2;53(22):2019-27
references: 19477350
references: BMC Health Serv Res. 2007 Aug 31;7:138
references: 17764560
references: Ann Card Anaesth. 2008 Jan-Jun;11(1):15-9
references: 18182754
references: Curr Opin Anaesthesiol. 2008 Oct;21(5):664-8
references: 18784496
references: Ann Thorac Surg. 2006 Dec;82(6):2323-34
references: 17126171
references: J Thromb Thrombolysis. 2006 Apr;21(2):167-74
references: 16622613
references: Ann Thorac Surg. 2011 Mar;91(3):944-82
references: 21353044
references: Am J Med. 1993 May;94(5):509-514
references: 8498396
references: Stat Med. 2003 Sep 15;22(17):2799-815
references: 12939787
references: Crit Care Med. 2009 Dec;37(12):3124-57
references: 19773646
references: Ann Thorac Surg. 2002 Oct;74(4):1180-6
references: 12400765
references: Circulation. 2007 Nov 27;116(22):2544-52
references: 17998460
references: JAMA. 1993 Oct 20;270(15):1832-6
references: 8411527
references: Crit Care Med. 2006 Jun;34(6):1608-16
references: 16607235
references: Transfusion. 2004 Oct;44(10):1453-62
references: 15383018
references: Arch Surg. 1998 Apr;133(4):442-7
references: 9565127
references: J Cardiothorac Vasc Anesth. 2005 Feb;19(1):26-31
references: 15747265
references: BMC Med. 2009 Jul 31;7:37
references: 19646221
references: Can J Anaesth. 2006 Aug;53(8):802-9
references: 16873347
references: Epidemiology. 1994 Sep;5(5):541-4
references: 7986870
references: Ann Thorac Surg. 1996 Aug;62(2):410-7; discussion 417-8
references: 8694599
references: JAMA. 2010 Oct 13;304(14):1568-75
references: 20940382
references: Anesth Analg. 2009 Jun;108(6):1741-6
references: 19448195
references: Ann Thorac Surg. 2007 May;83(5 Suppl):S27-86
references: 17462454