Transfusion Practice in Elderly Surgical Patients in Germany-A Secondary Data Analysis of over 21 Million Patients...

Background and Objectives: The aging population poses increasing challenges for perioperative care, particularly with respect to blood transfusion practices. This study evaluated transfusion patterns, associated risk factors, and outcomes among surgical patients aged 65 years and older. Materials and Methods: All hospitalized surgical patients in Germany between 1 January 2013, and 31 December 2022, were included. Patients aged ≥ 65 years were categorized as transfused (having received red blood cells (RBCs)) or non-transfused. Patients with overlapping procedures or unknown surgical disciplines were excluded. Comorbidities, anemia, bleeding, complications, and blood product use were analyzed using ICD and OPS codes. Results: A total of 21,143,317 surgical patients aged ≥ 65 years met the inclusion criteria; 2,640,608 (12%) received at least one RBC transfusion. The median age was 79 (73-85) years overall, 79 (73-85) years among transfused patients, and 76 (70-81) years among non-transfused patients. Women accounted for 55.0% of cases. The highest median Elixhauser comorbidity score was observed in patients aged 80-84 years and was significantly higher in transfused patients. Essential hypertension was the most common risk factor, while acute kidney injury was the most frequent complication. Length of stay, ventilation hours, and ICU admission rates decreased with increasing age. Patients aged 65 years and older had an odds ratio of 3.99 (3.98-4.00) for receiving a transfusion. Conclusions: In this observational study of surgical patients aged ≥ 65 years, the risk of receiving an RBC transfusion increased with age, whereas length of stay, ventilation time, and ICU admission rates decreased. These findings support individualized perioperative management strategies, emphasizing the appropriate evaluation and treatment of anemia and the rational use of blood products in older adults.