Transfusion practice in elderly patients across surgical disciplines in Germany - a secondary data analysis of over 21 million patients

Abstract

Background - Clinicians are increasingly confronted with elderly patients across nearly all surgical disciplines. Advanced age is an independent risk factor for complications, prolonged hospitalization, and particularly for red blood cell (RBC) transfusion. The elderly suffer more frequently from anemia, which is associated with higher perioperative transfusion requirements, increased complication rates, and mortality Surgical disciplines differ not only in primary diagnoses but also in the demographics of their typical patient population.

Material and methods - Hospitalized surgical patients in Germany between January 1^st, 2013, and December 31^st 2022, were analyzed. Inclusion criteria: Age ≥65 years, surgical disciplines: General surgery, Gynecology, Cardiac surgery, Thoracic surgery, Oral and Maxillofacial surgery, Neurosurgery, Trauma and Orthopedic surgery, Urology or Vascular surgery. Exclusion criteria included unknown or overlapping surgical procedures. Risk factors, comorbidities, transfusion rates, bleeding, complications, and blood product use were assessed using ICD and OPS (the German national procedure coding system) codes. The primary endpoint was RBC transfusion rate; the secondary endpoint was preoperative transfusion rate.

Results - A total of No.=21,143,317 patients were analyzed of which No.=2,640,608 (12%) received RBC transfusion. The highest transfusion rate was seen in Trauma and Orthopedic surgery (17.2% - No.=1,116,082). Trauma and Orthopedic surgery also had the highest risk (Odds Ratio [OR]) for RBC Transfusion (1.36 [1.35-1.36]). The highest preoperative transfusion rate was noted in general surgery, where 48.2% (No.=384,553) of the transfused patients received at least one RBC transfusion prior to surgery.

Discussion - Our study revealed that the highest transfusion rate in elderly patients is in Trauma and Orthopedic surgery, while the highest rate of preoperative transfusion was seen in General surgery. It would seem worthwhile to reduce these rates wherever possible, and these are the disciplines which offer the most room for improvement and would thus benefit most from consistent establishment of PBM programs.