Transfusion-associated circulatory overload (TACO) and potential risk factors among the inpatient US elderly as recorded in Medicare administrative databases during 2011

Background and Objectives Transfusion-associated circulatory overload (TACO) is a serious transfusion complication resulting in respiratory distress. The study's objective was to assess TACO occurrence and potential risk factors among elderly Medicare beneficiaries (ages 65 and older) in the inpatient setting during 2011. Materials and Methods This retrospective claims-based study utilized Medicare administrative databases in coordination with Centers for Medicare & Medicaid Services. Transfusions were identified by recorded procedure and revenue centre codes, while TACO was ascertained via ICD-9-CM diagnosis code. We evaluated TACO diagnosis code rates overall and by age, gender, race, number of units and blood components transfused. Multivariate logistic regression analyses were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results Among 2147038 inpatient transfusion stays for elderly in 2011, 1340 had TACO diagnosis code, overall rate of 624 per 100000 stays. TACO rates increased significantly with age and units transfused (P<00001). After adjustment for confounding, significantly higher odds of TACO were found for women vs. men (OR=140, 95% CI 126-160), White people vs. non-White people (OR=138, 95% CI 120-162) and persons with congestive heart failure (OR=161, 95% CI 144-188), chronic pulmonary disease (OR=119, 95% CI 108-132) and different anaemias. Conclusion Our study identified largest number of potential TACO cases to date and showed a substantial increase in TACO occurrence with age and number of units transfused. The study suggested increased TACO risk in elderly with congestive heart failure, chronic pulmonary disease and anaemias. Overall, study shows importance of large administrative databases as an additional epidemiological tool.