Let’s say your colleague’s patient is older than 65 years of age. Would she be more likely to transfuse the patient compared to a younger patient with the same hemoglobin level before transfusion? Dr. Charles H. Brown IV, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD and colleagues used their computerized anesthesia record system to analyze the effect of age (>65 years old vs ≤65 years old) on the likelihood of transfusion. Their work will be published in the article titled “Odds of Transfusion for Older Adults Compared to Younger Adults Undergoing Surgery” appeared in the June 2014 issue of Anesthesia & Analgesia.
Almost 21,000 patients who underwent surgery between August 2008 and February 2012 were studied. After adjusting for comorbidities, surgical service, and lowest hemoglobin, patients in the older group (>65 y/o) were 62% more likely (odds ratio 1.62) to receive a transfusion than younger patients. Almost 27% of older patients received a transfusion compared to 16% of younger patients. However, among patients receiving transfusions, age did not correlate with number of units transfused. Hemoglobin levels before, during, and after transfusion were statistically lower for older patients, but the authors did not consider the differences to be clinically significant.
The authors modeled the influence of patient comorbidity on the likelihood of transfusion. If a patient had cerebrovascular disease, peripheral vascular disease, or cardiac conduction abnormalities, the likelihood of transfusion was no different for older versus younger patients. For acute myocardial infarction, the likelihood of transfusion was higher if the patient was older. Patients on the orthopedic service, if older, were more likely to receive blood. Surgeons out of medical school for fewer years were also more likely to order blood for their older patients.
Although elderly patients were more likely to receive transfusions, even after adjusting for other risk factors, there appears to be no medical reason why age, per se, should influence the decision to transfusion patients. Given little evidence for age as a trigger, more education seems warranted. Perhaps this study will provide the basis for this education effort.