What is the clinical evidence from this study?

Study design: Observational. Population: Major surgery (CABG, total hip replacement, colectomy) (n=77037). Intervention: Black race vs. White race. Primary outcome: Receipt of perioperative red blood cell (RBC) transfusion during CABG (AOR 1.41, 95% CI 1.13-1.76, p=0.002).

March 11, 2014Open Access

Racial disparities in the use of blood transfusion in major surgery

Key Result

Black patients undergoing coronary artery bypass surgery had a 41% higher adjusted odds (AOR 1.41) of receiving perioperative red blood cell transfusions compared to white patients.

Study Design

Type

Observational (n=77,037)

Multicenter

Yes

PICO

Population

Major surgery (CABG, total hip replacement, colectomy) (n=77,037)

Intervention / Comparator

Black race vs White race

Primary Outcome

Receipt of perioperative red blood cell (RBC) transfusion during CABG — AOR 1.41 (1.13-1.76), p=0.002

Main Result

Effect estimate: AOR 1.41 (95% CI 1.13-1.76)

Absolute Event Rate: 58.4% vs 44.5%

p-value: p=0.002

Limitations

Preoperative hematocrit values were not available in the database to control for the severity of anemia.
Potential misclassification of race in the administrative database.
Reliance on administrative data and ICD-9 codes, limiting the ability to distinguish between complications of care and pre-existing conditions.
Possibility of residual confounding from unmeasured risk factors.
Blood usage information in the database was not audited.
Findings from academic medical centers may not be generalizable to non-academic hospitals.

Abstract

BACKGROUND: Racial disparities in healthcare in the United States are widespread and have been well documented. However, it is unknown whether racial disparities exist in the use of blood transfusion for patients undergoing major surgery. METHODS: We used the University HealthSystem Consortium database (2009-2011) to examine racial disparities in perioperative red blood cells (RBCs) transfusion in patients undergoing coronary artery bypass surgery (CABG), total hip replacement (THR), and colectomy. We estimated multivariable logistic regressions to examine whether black patients are more likely than white patients to receive perioperative RBC transfusion, and to investigate potential sources of racial disparities. RESULTS: After adjusting for patient-level factors, black patients were more likely to receive RBC transfusions for CABG (AOR = 1.41, 95% CI: 1.13, 1.76, p = 0.002) and THR (AOR = 1.39, 95% CI: 1.20, 1.62, p < 0.001), but not for colectomy (AOR = 1.08, 95% CI: 0.90, 1.30, p = 0.40). Black-white disparities in blood transfusion persisted after controlling for patient insurance and hospital effects (CABG: AOR = 1.42, 95% CI: 1.30, 1.56, p < 0.001; THR: AOR = 1.43, 95% CI: 1.29, 1.58, p < 0.001). CONCLUSIONS: We detected racial disparities in the use of blood transfusion for CABG and THR (black patients tended to receive more transfusions compared with whites), but not for colectomy. Reporting racial disparities in contemporary transfusion practices may help reduce potentially unnecessary blood transfusions in minority patients.

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