title: Increased hospital costs associated with red blood cell transfusion.
abstract: BACKGROUND
  Red blood cell (RBC) transfusion is independently associated in a dose-dependent manner with increased intensive care unit stay, total hospital length of stay, and hospital-acquired complications. Since little is known of the cost of these transfusion-associated adverse outcomes our aim was to determine the total hospital cost associated with RBC transfusion and to assess any dose-dependent relationship.
  
  
  METHODS
  A retrospective cohort study of all multiday acute care inpatients discharged from a five hospital health service in Western Australia between July 2011 and June 2012 was conducted. Main outcome measures were incidence of RBC transfusion and mean inpatient hospital costs.
  
  
  RESULTS
  Of 89,996 multiday, acute care inpatient discharges, 4805 (5.3%) were transfused at least 1 unit of RBCs. After potential confounders were adjusted for, the mean inpatient cost was 1.83 times higher in the transfused group compared with the nontransfused group (95% confidence interval, 1.78-1.89; p < 0.001). The estimated total hospital-associated cost of RBC transfusion in this study was AUD $77 million (US $72 million), representing 7.8% of total hospital expenditure on acute care inpatients. There was a significant dose-dependent association between the number of RBC units transfused and increased costs after adjusting for confounders.
  
  
  CONCLUSIONS
  RBC transfusions were independently associated with significantly higher hospital costs. The financial implication to hospital budgets will assist in prioritizing areas to reduce the rate of RBC transfusions and in implementing patient blood management programs.
authors.affiliation: Performance Unit, South Metropolitan Health Service, Perth, Western Australia.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Trentino
authors.affiliation: School of Surgery, University of Western Australia, Perth, Western Australia.|Centre for Population Health Research, Curtin University, Perth, Western Australia.
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Farmer
authors.affiliation: Performance Unit, South Metropolitan Health Service, Perth, Western Australia.
authors.forename: Stuart G
authors.initials: SG
authors.lastname: Swain
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia.
authors.forename: Sally A
authors.initials: SA
authors.lastname: Burrows
authors.affiliation: School of Surgery, University of Western Australia, Perth, Western Australia.|Centre for Population Health Research, Curtin University, Perth, Western Australia.
authors.forename: Axel
authors.initials: A
authors.lastname: Hofmann
authors.affiliation: Performance Unit, South Metropolitan Health Service, Perth, Western Australia.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Ienco
authors.affiliation: Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Western Australia.
authors.forename: Warren
authors.initials: W
authors.lastname: Pavey
authors.affiliation: Royal Perth Group, South Metropolitan Health Service, Perth, Western Australia.|Center for Clinical Research in Emergency Medicine, University of Western Australia, Perth, Western Australia.
authors.forename: Frank F S
authors.initials: FF
authors.lastname: Daly
authors.affiliation: Department of Anaesthesiology, Fremantle Hospital, Fremantle, Western Australia.
authors.forename: Anton
authors.initials: A
authors.lastname: Van Niekerk
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia.|School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria.
authors.forename: Steven A R
authors.initials: SA
authors.lastname: Webb
authors.affiliation: Department of Intensive Care, Royal Perth Hospital, Perth, Western Australia.|Service 4, Fiona Stanley Hospital, Perth, Western Australia, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Towler
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia.|Department of Haematology, PathWest, Fremantle Hospital, Fremantle, Western Australia.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Leahy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017707:Erythrocyte Transfusion / Q000191:economics*; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000191:economics; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies