Open Access Open Badges Research article

Racial disparities in the use of blood transfusion in major surgery

Feng Qian1*, Michael P Eaton2, Stewart J Lustik2, Samuel F Hohmann34, Carol B Diachun2, Robert Pasternak2, Richard N Wissler2 and Laurent G Glance2

Author Affiliations

1 Department of Health Policy, Management, and Behavior, University at Albany School of Public Health, One University Place, GEC 169, 12144-3445 Rensselaer, NY, USA

2 Department of Anesthesiology, University of Rochester School of Medicine, Rochester, NY, USA

3 Principal Consultant, Comparative Data & Information Research, University HealthSystem Consortium, Chicago, IL, USA

4 Department of Health Systems Management, Rush University, Chicago, IL, USA

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BMC Health Services Research 2014, 14:121  doi:10.1186/1472-6963-14-121

Published: 11 March 2014



Racial disparities in healthcare in the United States are widespread and have been well documented. However, it is unknown whether racial disparities exist in the use of blood transfusion for patients undergoing major surgery.


We used the University HealthSystem Consortium database (2009-2011) to examine racial disparities in perioperative red blood cells (RBCs) transfusion in patients undergoing coronary artery bypass surgery (CABG), total hip replacement (THR), and colectomy. We estimated multivariable logistic regressions to examine whether black patients are more likely than white patients to receive perioperative RBC transfusion, and to investigate potential sources of racial disparities.


After adjusting for patient-level factors, black patients were more likely to receive RBC transfusions for CABG (AOR = 1.41, 95% CI: [1.13, 1.76], p = 0.002) and THR (AOR = 1.39, 95% CI: [1.20, 1.62], p < 0.001), but not for colectomy (AOR = 1.08, 95% CI: [0.90, 1.30], p = 0.40). Black-white disparities in blood transfusion persisted after controlling for patient insurance and hospital effects (CABG: AOR = 1.42, 95% CI: [1.30, 1.56], p < 0.001; THR: AOR = 1.43, 95% CI: [1.29, 1.58], p < 0.001).


We detected racial disparities in the use of blood transfusion for CABG and THR (black patients tended to receive more transfusions compared with whites), but not for colectomy. Reporting racial disparities in contemporary transfusion practices may help reduce potentially unnecessary blood transfusions in minority patients.