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Background <p>Red blood cell transfusion is a well-studied intervention with numerous randomized trials to guide management, yet practice remains highly variable.</p> Objective <p>In this study, we explored hospital and patient factors influencing red cell transfusion in a large multi-center database of hospitalized patients.</p> Design <p>Retrospective analysis</p> Participants <p>All adults admitted at hospitals in the GEMINI database—a multi-center inpatient database in Ontario, Canada, between December 2016 and June 2022.</p> Main Measures <p>The pre-specified primary analysis compared average treatment effect (ATE) of hemoglobin value on transfusion probability in general internal medicine (GIM) patients by hospital type (teaching or non-teaching) and selected medical diagnoses.</p> Key Results <p>The primary analysis cohort consisted of 525,510 GIM patients from 24 hospitals. The overall cohort had a 24-h transfusion probability of 79.2% in the &lt; 6.0&#xa0;g/dL range, 76.2% in the 6.0–6.9&#xa0;g/dL range, 18.2% in the 7.0–7.9&#xa0;g/dL range, and 1.1% in the &gt; 8.0&#xa0;g/dL range. In comparative primary analyses based on medical diagnosis, transfusion probability was higher in the 6.0–6.9&#xa0;g/dL range for patients presenting to non-teaching hospitals with sickle cell disease (28.7% vs 11.9%, ATE 16.8%, 95% CI 12.6–21.0, <i>p</i> &lt; 0.001), cardiac disease (80.5% vs 75.8%, ATE 4.7%, 95% CI 3.4–5.9, <i>p</i> &lt; 0.001), and gastrointestinal bleeding (87.8% vs 86.1%, ATE 1.8%, 95% CI 0.9–2.6, <i>p</i> &lt; 0.003), and similar for patients with iron deficiency (77% vs 76.5%, ATE 0.5%, 95% CI 0.6–1.6, <i>p</i> = 0.39).</p> Conclusions <p>In this longitudinal cohort study, GIM patients with sickle cell and cardiac disease faced substantially different probabilities of red cell transfusion at teaching and non-teaching hospitals.</p>

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Red Cell Transfusion in General Medicine Patients at Teaching and Non-teaching Hospitals: A Retrospective Cohort Analysis

  • 期刊论文

  • 发表日期：

    2025年10月28日

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  • Sheharyar Raza,
  • Malcolm Risk,
  • Anne Loeffler,
  • Amol A. Verma,
  • Fahad Razak,
  • Donald Arnold,
  • Dean Fergusson,
  • Sarah Ryan,
  • Nicole Relke,
  • Nadia Gabarin,
  • Na Li,
  • Rachel Nguyen,
  • Kathrin Tyryshkin,
  • Surain Roberts,
  • Jeannie Callum

摘要

Background

Red blood cell transfusion is a well-studied intervention with numerous randomized trials to guide management, yet practice remains highly variable.

Objective

In this study, we explored hospital and patient factors influencing red cell transfusion in a large multi-center database of hospitalized patients.

Design

Retrospective analysis

Participants

All adults admitted at hospitals in the GEMINI database—a multi-center inpatient database in Ontario, Canada, between December 2016 and June 2022.

Main Measures

The pre-specified primary analysis compared average treatment effect (ATE) of hemoglobin value on transfusion probability in general internal medicine (GIM) patients by hospital type (teaching or non-teaching) and selected medical diagnoses.

Key Results

The primary analysis cohort consisted of 525,510 GIM patients from 24 hospitals. The overall cohort had a 24-h transfusion probability of 79.2% in the < 6.0 g/dL range, 76.2% in the 6.0–6.9 g/dL range, 18.2% in the 7.0–7.9 g/dL range, and 1.1% in the > 8.0 g/dL range. In comparative primary analyses based on medical diagnosis, transfusion probability was higher in the 6.0–6.9 g/dL range for patients presenting to non-teaching hospitals with sickle cell disease (28.7% vs 11.9%, ATE 16.8%, 95% CI 12.6–21.0, p < 0.001), cardiac disease (80.5% vs 75.8%, ATE 4.7%, 95% CI 3.4–5.9, p < 0.001), and gastrointestinal bleeding (87.8% vs 86.1%, ATE 1.8%, 95% CI 0.9–2.6, p < 0.003), and similar for patients with iron deficiency (77% vs 76.5%, ATE 0.5%, 95% CI 0.6–1.6, p = 0.39).

Conclusions

In this longitudinal cohort study, GIM patients with sickle cell and cardiac disease faced substantially different probabilities of red cell transfusion at teaching and non-teaching hospitals.