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Arch Pathol Lab Med 1998 Feb; 122(2):145-51.

Allogeneic blood transfusion, hospital charges, and length of hospitalization: A study of 487 consecutive patients undergoing colorectal cancer resection.

Vamvakas EC, Carven JH.

Massachusetts General Hospital, and Department of Pathology, Harvard Medical School, Boston, USA. Abstract: OBJECTIVE: To investigate the independent association of allogeneic blood transfusion with longer hospital stays and higher hospital charges, after adjustment for the effects of confounding factors that are related to both these outcomes and the receipt of a perioperative transfusion. DESIGN AND METHODS: The records of 487 consecutive patients undergoing colorectal cancer resection and assigned a diagnosis-related group code between 146 and 149 were reviewed. The influence of allogeneic transfusion in explaining the variation in the observed length of stay and total hospital charges was calculated after adjustment for the effects of 20 confounding factors that related to severity of illness, difficulty of operation, and risk of postoperative infection. RESULTS: Length of stay (mean +/- SE) was 16.7 +/- 0.81 days in the transfused group, compared with 10.3 +/-0.26 days in the untransfused group (P < .0001); hospital charges were $28101 +/- 1121 and $15978 +/- 265, respectively (P < .0001). After adjustment for the effects of 20 confounding factors, length of stay increased by 1.3% (95% confidence interval 0.5% to 2.1%) per unit of red blood cells and/or platelets transfused (P < .001), and hospital charges increased by 2.0% (95% confidence interval, 1.4% to 2.6%) per unit (P < .001). CONCLUSION: Allogeneic transfusion was independently associated with longer hospital stays and higher hospital charges. This association may be due to a relationship between allogeneic transfusion and a higher incidence of septic complications of surgery or may reflect the function of blood transfusion as a surrogate marker for severity of illness. The editorial comments by Dr. Neil Blumberg and Dr. Joanna Heal in the same issue (Arch Pathol Lab Med 1998 Feb;122(2):117-9) highlight the strong association between perioperative blood transfusion and immune suppression. Their editorial is entitled "Blood transfusion immunomodulation: the silent epidemic."

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