Age of transfused red blood cells and health outcomes in two surgical cohorts.
Sikandar H Khan, Rohit Devnani, Michelle LaPradd and 6 others
PMID 30227992WHAT IT FOUND
Older blood, stored 28 days or longer, was associated with higher mortality in some hip fracture and CABG outcomes, while length of stay and readmission rates did not differ.
This observational study cannot prove cause.
Key findings
01In hip fracture surgery, old blood was associated with higher adjusted odds of inpatient mortality (OR 166.8, 95% CI 1.067 to greater than 100), while unadjusted mortality differences were not significant.
02In CABG, old blood was associated with higher 30-day mortality (4.7% versus 1.0%, p=0.02) and higher adjusted odds of 30-day mortality (OR 4.55, 95% CI 1.01 to 20.49, p=0.03).
03Length of stay did not differ between young and old blood groups, and readmission rates did not differ, except that median time to 90-day readmission was shorter in the young hip fracture group (p=0.04).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a retrospective record-based study, so it can show association but cannot prove that older blood caused death. Most patients received mixed blood ages, so the strict young-versus-old comparison involved fewer patients and small numbers of deaths. The hip fracture adjusted odds ratio for inpatient mortality was extremely wide (1.067 to greater than 100), and unadjusted hip mortality differences were not significant. Results applied only to hip fracture surgery and CABG patients, not other medical or surgical patients. Researchers applied several data constraints, including transfusion unit limits and other clinical cut-offs, which may limit generalisability.
Declared interests
The supplied text does not include a conflicts-of-interest declaration. The journal metadata lists research support from NIH Extramural and non-US government.
The easy way to misread this
Do not conclude that giving fresher blood will reduce mortality. This retrospective study found associations, not treatment effects, and the hip fracture adjusted odds ratio for inpatient mortality has a confidence interval extending above 100 while unadjusted hip mortality differences were not significant.