Hospitalizations with blood transfusions and transfusion-related adverse events in US acute care hospitals, 2016-2020

National data on transfusion-related adverse events (TAEs) in the United States are limited. Administrative and payment-related data may augment hemovigilance systems to assess transfusion safety.

A nationwide administrative database was analyzed to characterize transfusion-related hospitalizations and TAEs by trends, patient/hospital characteristics, and outcomes. Transfusions and TAEs were identified using medical codes and charges. Generalized estimating equations (GEE) modeled transfusion trends, while logistic regression assessed transfusion-associated circulatory overload (TACO) and transfusion-related acute lung injury (TRALI) risk factors.

During 2016-2020, 8.4% of hospitalizations involved transfusions, with red blood cell (RBC) transfusion being most common (5.2%). In 2020, compared to 2016, hospitalizations with RBC transfusion decreased by 2% (Rate Ratio (RR) 0.98; 95% CI: 0.97-0.99), while plasma transfusion hospitalizations increased by 13% (RR 1.13; 95% CI: 1.08-1.19). TAEs occurred in 0.35% of hospitalizations (3.5/1000 transfusion hospitalizations). Among the TAEs included in the study, TACO, febrile nonhemolytic reactions, and TRALI were most common. In 27% of cases, the specific TAE was unidentified. TAEs were associated with higher inpatient mortality and longer lengths of stay. Variability in TAE rates was observed by patient and hospital characteristics. Risk factors for TACO included age >64, female sex, teaching hospitals, rural location, and Northeast region. TRALI risk was higher in teaching hospitals and those with >200 beds.

Administrative data provide insights into transfusion practices and associated morbidity and mortality but have limitations. Linking administrative, electronic health record, and blood bank data may enhance TAE identification.