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Study Finds Racial Disparities in use of Blood Transfusion in Major Surgery

Blood transfusion, once considered a low-risk procedure used to offset anemia, is itself associated with adverse outcomes in patients undergoing cardiac and noncardiac surgical procedures.

ALBANY, N.Y. (May 8, 2014) -- Black patients in the U.S. are more likely to receive perioperative red blood cell (RBC) transfusions for two of three frequently performed surgical procedures, posing a risk for favorable outcomes, a study by University at Albany School of Public Health researcher Feng Qian finds.

The report cites three common surgeries -- coronary artery bypass surgery, total hip replacement, and colectomy. The findings indicate that black patients, most often younger and under-insured, had more comorbidities and were more likely to receive RBC transfusions for two of the three procedures examined.

The study found black patients undergoing coronary artery bypass surgery had a 41 percent higher incidence of receiving a perioperative RBC transfusion and blacks undergoing total hip replacement had 39 percent higher incidence of transfusion.

Blood transfusion is widely employed in contemporary surgical practices. The majority of the 15 million units of allogeneic RBCs transfused annually in the United States are administered to patients undergoing surgical procedures.

Blood transfusions are common
Yet blood transfusion, once considered a relatively low-risk procedure used to offset anemia, is itself associated with adverse outcomes in patients undergoing cardiac and noncardiac surgical procedures, including in-hospital mortality and postoperative complications.

The study, "Racial disparities in the use of blood transfusion in major surgery," published in the peer-reviewed journal BMC Health Services Research, examined the use of perioperative RBCs using patient data from the University HealthSystem Consortium, a network of academic medical centers and affiliated hospitals. Data represented 90 percent of the contemporary hospitalizations at academic medical centers.

The data were fully encrypted so as not to identify specific patients, physicians, or hospitals. In addition to patient demographic characteristics, admission status, diagnoses, procedures, present-on-admission, severity of illness, and a comprehensive set of comorbidities, detailed information about inpatient blood transfusion was available. 

Racial gaps
It is generally known racial disparities related to health and mortality exist. Racial gaps related to access to health care and quality of care exist and have persisted. Research has shown blacks have significantly higher rates of medical interventions suggestive of less than optimal management of chronic diseases, are more likely to receive care from lower-quality physicians and lower-quality hospitals and, overall, have a higher age-adjusted mortality rate than whites. Recent studies indicate a wide variation in the use of blood transfusion during surgery, with the associated adverse outcomes.

The UAlbany study sought to address whether the higher rate of perioperative RBC transfusion in black patients is caused by segregation or discrimination. The outcome variable studied was whether a patient received any perioperative RBC transfusion.

Transfusion overuse poses risks
Overuse of blood transfusions, the study concluded, may pose serious health risks, specifically in black patients undergoing coronary artery bypass surgery and total hip replacement surgical procedures. Qian further concluded that recognition of racial disparities related to use of perioperative RBC transfusions may help reduce potentially unnecessary blood transfusions in minority patients.


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