Background/Case Studies: Older adults are at increased likelihood for transfusion and may be at higher risk for adverse outcomes from transfusion. The study objective was to investigate blood use among inpatient Medicare beneficiaries, ages 65+, transfused during 2007-2021.
Study
Design/Methods: This retrospective study used Medicare databases to evaluate the mean number of units per stay overall, annually, and by 2 years pre- and during COVID-19 pandemic, demographics, mutually exclusive blood component groups, immunocompromised (IC) and COVID-19 status. Revenue center and procedure codes identified transfusions, and revenue center units quantified units per transfusion stay.
Results/Findings: Of 19.2 million inpatient transfusion stays for Medicare beneficiaries ages 65+ during 2007-2021, 80.3 million units were transfused, 4.18 mean units per stay overall and 4.74 for IC and 4.05 for non-IC beneficiaries. Overall annual units per stay declined from 4.76 in 2007 to 3.52 in 2021, for IC: 5.68 to 3.99, and for non-IC: 4.62 to 3.37. Mean units for ages 65-69, 70-74, 75-79, 80-84, 85+ were: 4.87, 4.58, 4.36, 3.99, and 3.33. Mean units for males and females were 4.72 and 3.75, and for whites vs. non-whites 4.17 vs. 4.20. The highest use was for the RBCs, platelets, and plasma (19.58) group. Two-year pre-pandemic vs. pandemic overall mean units per stay were 3.78 and 3.57. In contrast, higher mean units during pandemic were identified for platelets only: 3.20 vs. 2.98; and for non-COVID-19 plasma only users: 3.81 vs. 3.68, among few other components. During pandemic, mean units transfused for COVID-19 vs. non-COVID-19 transfusion stays were 2.96 and 3.62. However, COVID-19 patients had higher mean units transfused for RBCs only: 2.81 vs. 2.69, and for RBCs and platelets: 8.18 vs. 8.09. Among COVID-19 transfusion stays, 45.1% had Convalescent Plasma (CP) only and 3.1% had CP transfused with other blood components, with corresponding mean units of 1.82 and 4.50. Conclusions: This study shows that mean inpatient blood utilization, per transfusion stay, declined during 2007-2021 among Medicare beneficiaries aged 65+, overall and by IC status. Higher blood utilization was identified for IC vs. non-IC, males vs. females, younger vs. older patients, and component combinations vs. single blood components. Overall, lower blood utilization was identified during pandemic vs. pre-pandemic and for COVID-19 vs. non-COVID-19 stays except for specific blood component groups which needs further investigation. The findings may in part be due to the large fraction of COVID-19 transfusion stays with CP only use which was associated with fewer mean units transfused. Future pandemic and post-pandemic blood use research is needed in various healthcare settings to help assure adequate national blood supply.
Importance of research: This study utilized large real-world Medicare data to evaluate blood utilization during 2007-2021 among inpatient beneficiaries ages 65+. The study assessed trends over time, including 2 years pre- (Jan 2018-Dec 2019) and during (Apr 2020-Dec 2021) the COVID-19 pandemic, and by demographics, blood components, immunocompromised (IC) and COVID-19 status to better understand blood use and help assure adequate national blood supply and safety.
