The Overtransfusion Epidemic

Transfusions are the single most commonly billed hospital in-patient procedure. 15 million transfusions are performed annually in the U.S., with a direct cost of $10-$15 billion annually. A recent study by Premier, a healthcare performance improvement alliance of approximately 2,900 U.S. community hospitals and 100,000 alternate sites, looked at 464 member hospitals and concluded that blood utilization represents the eighth highest savings opportunity for hospitals – a savings of $1.06 million per hospital, per year.

Empirical distribution of percentage morbidity with respect to difference between actually transfused and model-estimated numbers of packs of red blood cells (PRBC). Source: Simeone et al. BMC Medical Informatics and Decision Making. 2011, 11:44

Empirical distribution of percentage morbidity with respect to difference between actually transfused and model-estimated numbers of packs of red blood cells (PRBC). Source: Simeone et al. BMC Medical Informatics and Decision Making. 2011, 11:44

Overuse 

Up to 60% of RBC transfusions are inappropriate. [1] A recent study of 48,000 patients at Johns Hopkins reported wide variability in intraoperative blood use among clinicians when using Hb (g/dl) values to trigger transfusions [2]

Risk

Blood transfusion significantly increases patient risk of mortality (88%), infections (69%), and acute respiratory distress syndrome, ARDS (250%) [3] and cancer recurrence (42%) [4]

 

Cost

The direct cost of an RBC unit is estimated to be as high as  $1,183/unit, [5] and the incremental cost of bleeding-related complications and transfusion is reported to be as high as $17,279 per patient. [6]

 

“Blood conservation is one of the few areas in medicine where outcomes can be improved, risk reduced, and costs saved, all at the same time.” 

Steven Frank, MD
Johns Hopkins University