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Racial Disparities in the use of Blood Transfusion in Major Surgery

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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