Potential Factors Affecting Transfusion Policy and Length of Hospitalization in Patients with Thermal Injury

Background: To explore the potential factors affecting time to discharge alive among burn patients and to determine the appropriateness of restrictive and liberal transfusion policies for burn patients. Study design and method: A retrospective analysis of 66 burn patients was conducted from 2013 to 2015. The average age was 26.7 and TBSA was 42.1% ( ± 25.9%). Data exploration of all dependent variables was performed to determine the normality and non-normally distributed variables were converted using Templeton’s two-step transformation involving percentile ranking. We assessed associations between significant clinical factors from and the outcome using Cox proportional hazards regression models with fixed and time-varying covariates. Impact of different transfusion threshold on the LOS was estimated by Cox proportional hazards regression and Kaplan-Meier curve. Results: A higher ABSI score (adj. HR, 0.28; P=0.017), present of bacteremia (adj. HR, 0.19; P=0.002) and pRBC transfusion (adj. HR, 0.55; P=0.001) were associated with significantly lower hazards of hospital discharge, suggesting a longer hospital stay. Further, the “restrictive” group also had a better outcome regarding the length of ICU stay (P=0.006) and hospital stay (P=0.003). There was a longer length of hospital stay in hemoglobin threshold greater than 8.5 g/ dl patients. (Log rank test, P=0.001). Transfusion threshold per se played an important role in extending the length of hospitalization (P=0.019). Conclusions: Restrictive RBC transfusion policy is more favorable to order appropriate blood components and helps the healthcare system to shorten LOS, reduce cost and complications.