Irwin Gross1,2, Burkhardt Seifert3, Axel Hofmann3, Donat R Spahn3. 1. Patient Blood Management Program, Eastern Maine Medical Center, Bangor, Maine. 2. Department of Hematology and Oncology, Eastern Maine Medical Center, Bangor, Maine. 3. Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
Abstract
BACKGROUND: The aim of this study was to investigate the impact of the introduction of a patient blood management (PBM) program in cardiac surgery on transfusion incidence and outcome. STUDY DESIGN AND METHODS: Clinical and transfusion data were compared between the pre-PBM epoch (July 2006-March 2007) and the PBM epoch (April 2007-September 2012). RESULTS: There were a total of 2662 patients analyzed, 387 in the pre-PBM and 2275 in the PBM epoch. Red blood cell (RBC) loss decreased from a mean (±SD) of 810 ± 426 mL (median, 721 mL) to 605 ± 369 mL (median, 552 mL; p < 0.001) and pretransfusion hemoglobin decreased from 7.2 ± 1.4 to 6.6 ± 1.2 g/dL (p < 0.001) in the pre-PBM versus the PBM epoch. In conjunction, this resulted in a reduction of the RBC transfusion rate from 39.3% to 20.8% (p < 0.001). Similar reductions were observed for the transfusion of fresh-frozen plasma (FFP; from 18.3% to 6.5%, p < 0.001) and platelets (PLTs; from 17.8% to 9.8%, p < 0.001). Hospital mortality and cerebral vascular accident incidence remained unchanged in the PBM epoch. However, the incidence of postoperative kidney injury decreased in the PMB epoch (from 7.6% to 5.0%, p = 0.039), length of hospital stay decreased from 12.2 ± 9.6 days (median, 10 days) to 10.4 ± 8.0 days (median, 8 days; p < 0.001), and total adjusted direct costs were reduced from $48,375 ± $28,053 (median, $39,709) to $44,300 ± $25,915 (median, $36,906; p < 0.001). CONCLUSIONS: Implementing meticulous surgical technique, a goal-directed coagulation algorithm, and a more restrictive transfusion threshold in combination resulted in a substantial decrease in RBC, FFP, and PLT transfusions; less kidney injury; a shorter length of hospital stay; and lower total direct costs.
BACKGROUND: The aim of this study was to investigate the impact of the introduction of a patient blood management (PBM) program in cardiac surgery on transfusion incidence and outcome. STUDY DESIGN AND METHODS: Clinical and transfusion data were compared between the pre-PBM epoch (July 2006-March 2007) and the PBM epoch (April 2007-September 2012). RESULTS: There were a total of 2662 patients analyzed, 387 in the pre-PBM and 2275 in the PBM epoch. Red blood cell (RBC) loss decreased from a mean (±SD) of 810 ± 426 mL (median, 721 mL) to 605 ± 369 mL (median, 552 mL; p < 0.001) and pretransfusion hemoglobin decreased from 7.2 ± 1.4 to 6.6 ± 1.2 g/dL (p < 0.001) in the pre-PBM versus the PBM epoch. In conjunction, this resulted in a reduction of the RBC transfusion rate from 39.3% to 20.8% (p < 0.001). Similar reductions were observed for the transfusion of fresh-frozen plasma (FFP; from 18.3% to 6.5%, p < 0.001) and platelets (PLTs; from 17.8% to 9.8%, p < 0.001). Hospital mortality and cerebral vascular accident incidence remained unchanged in the PBM epoch. However, the incidence of postoperative kidney injury decreased in the PMB epoch (from 7.6% to 5.0%, p = 0.039), length of hospital stay decreased from 12.2 ± 9.6 days (median, 10 days) to 10.4 ± 8.0 days (median, 8 days; p < 0.001), and total adjusted direct costs were reduced from $48,375 ± $28,053 (median, $39,709) to $44,300 ± $25,915 (median, $36,906; p < 0.001). CONCLUSIONS: Implementing meticulous surgical technique, a goal-directed coagulation algorithm, and a more restrictive transfusion threshold in combination resulted in a substantial decrease in RBC, FFP, and PLT transfusions; less kidney injury; a shorter length of hospital stay; and lower total direct costs.
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