The Cost of Downstream Adverse Outcomes Associated with Allogeneic Blood Transfusion: A Retrospective Observational Cohort Study

Michelle Roets; David John Sturgess; Kerstin Hildegard Wyssusek; Sung Min Lee; Melinda Margaret Dean; Andre van Zundert

doi:10.3390/healthcare13050503

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The Cost of Downstream Adverse Outcomes Associated with Allogeneic Blood Transfusion: A Retrospective Observational Cohort Study

Journal article

Open access

Peer reviewed

The Cost of Downstream Adverse Outcomes Associated with Allogeneic Blood Transfusion: A Retrospective Observational Cohort Study

Michelle Roets, David John Sturgess, Kerstin Hildegard Wyssusek, Sung Min Lee, Melinda Margaret Dean and Andre van Zundert

Healthcare, Vol.13(5), pp.1-18

2025

DOI: https://doi.org/10.3390/healthcare13050503

PMCID: PMC11899157

PMID: 40077065

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Abstract

allogeneic blood transfusion

cost of adverse outcomes

intraoperative cell salvage

Background: ‘Downstream’ adverse outcomes associated with transfusion-related immune modulation (TRIM) occur postoperatively. The potential associations between these outcomes (and costs) and perioperative transfusion are often not considered by clinicians and therefore underestimated. When considering TRIM, many advantages of intraoperative cell salvage (ICS) were previously confirmed. Methods: The main aim of this retrospective observational study was to evaluate the cost implications associated with perioperative adverse outcomes following allogeneic blood transfusion (ABT). Secondly, further analysis considered downstream costs following ICS. This manuscript does not aim to provide evidence of improved outcomes following ICS compared to ABT. These outcomes were previously demonstrated. Instead, it is important to consider downstream cost implications if patients receive ABT, despite previously proven benefits related to ICS. Surgical patients (n = 2129) receiving blood transfusion at the Royal Brisbane and Women’s Hospital (Queensland, Australia) (2016–2018) were included: receiving ICS only (n = 115), allogeneic red blood cells (RBCs) only (n = 1944), or RBCs and ICS (n = 70). Data retrieved from eight hospital databases were exported, and a novel Structured Query Language (SQL) database was developed to link data points. Adverse outcomes previously associated with TRIM were assessed using International Classification of Diseases-10 (ICD-10) coded data. Generalised linear models were used to model costs and adjust for confounding factors. Results: Most adverse outcomes (≥3) occurred following RBCs and ICS (37.1%), followed by RBCs (23.7%) and ICS (16.5%). As potentially important determinants of overall expenditure, the lowest marginal mean intensive care stay (days, cost) was after ICS (2.1 days, AUD 10,027), followed by RBCs and ICS (3.8 days, AUD 18,089), and then RBCs (5.5 days, AUD 26,071). When considering blood products (other than packed red blood cells), the average cost per patient was lowest for ICS (AUD 48), followed by RBCs (AUD 533) and RBCs and ICS (AUD 819). Conclusions: We confirmed that the cost associated with allogeneic blood transfusion was significant; patients receiving packed red blood cells (pRBCs) experienced more adverse outcomes and higher hospital costs than those receiving ICS. These results are limited to retrospective data and require further prospective validation.

Details

Title: The Cost of Downstream Adverse Outcomes Associated with Allogeneic Blood Transfusion: A Retrospective Observational Cohort Study
Authors: Michelle Roets (Corresponding Author) - Royal Brisbane and Women's Hospital
David John Sturgess - Princess Alexandra Hospital
Kerstin Hildegard Wyssusek - The University of Queensland
Sung Min Lee - Royal Brisbane and Women's Hospital
Melinda Margaret Dean - University of the Sunshine Coast, Queensland, School of Health - Biomedicine
Andre van Zundert - Royal Brisbane and Women's Hospital
Publication details: Healthcare, Vol.13(5), pp.1-18
Publisher: MDPI AG
Date published: 2025
DOI: 10.3390/healthcare13050503
ISSN: 2227-9032
PMID: 40077065; PMC11899157
Copyright note: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Data Availability: The dataset supporting the conclusions of this article is included within the manuscript in a deidentified format.
Grant note: This work was supported by scholarship grant funding (towards Roets’ PhD studies with the University Queensland) from the RBWH and the RBWH Foundation (Brisbane, Queensland, Australia) (towards 2018, 2019 and 2020). Also, kind support was received from many departments and staff members at the RBWH, Metro North Hospital and Health Service (MNHHS), The University of Queensland (UQ), Queensland Institute of Medical Research Berghofer (QIMRB), and Queensland Pathology.
Organisation Unit: School of Health - Biomedicine
Language: English
Record Identifier: 991110914602621
Output Type: Journal article

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