BACKGROUND: Blood transfusions are a common and costly intervention for cardiac surgery patients. Evidence suggests that a more restrictive transfusion strategy may reduce costs and transfusion-related complications without increasing perioperative morbidity and mortality. STUDY DESIGN AND METHODS: A transfusion-limiting protocol was developed and implemented in a cardiovascular surgery unit. Over a 5-year period, data were collected on patient characteristics, procedures, utilization of blood products, morbidity, and mortality, and these were compared before and after the protocol was implemented. RESULTS: After the protocol was put in place, fewer patients required transfusions (38.2% vs. 45.5%, p = 0.004), with the greatest reduction observed in postoperative blood use (29.1% vs. 37.2%, p = 0.001). In-hospital morbidity and mortality did not increase. When patients who received transfusions were stratified by procedure, the protocol was most effective in reducing transfusions for patients undergoing isolated coronary artery bypass grafting (CABG; 4.09 units vs. 2.51 units, p = 0.009) and CABG plus valve surgery (10.32 units vs. 4.77 units, p = 0.014). A small group of patients were disproportionate recipients of transfusions, with approximately 6% of all patients receiving approximately half of the blood products. CONCLUSION: A protocol to limit transfusions decreased the proportion of cardiothoracic surgery patients who received blood products. A very small group of patients received a large number of transfusions, and within that group the observed mortality was significantly higher than in the general patient population. Current protocols cannot possibly account for these patients, and this should be considered when analyzing the performance of protocols designed to reduce unnecessary transfusions.
BACKGROUND: Blood transfusions are a common and costly intervention for cardiac surgery patients. Evidence suggests that a more restrictive transfusion strategy may reduce costs and transfusion-related complications without increasing perioperative morbidity and mortality. STUDY DESIGN AND METHODS: A transfusion-limiting protocol was developed and implemented in a cardiovascular surgery unit. Over a 5-year period, data were collected on patient characteristics, procedures, utilization of blood products, morbidity, and mortality, and these were compared before and after the protocol was implemented. RESULTS: After the protocol was put in place, fewer patients required transfusions (38.2% vs. 45.5%, p = 0.004), with the greatest reduction observed in postoperative blood use (29.1% vs. 37.2%, p = 0.001). In-hospital morbidity and mortality did not increase. When patients who received transfusions were stratified by procedure, the protocol was most effective in reducing transfusions for patients undergoing isolated coronary artery bypass grafting (CABG; 4.09 units vs. 2.51 units, p = 0.009) and CABG plus valve surgery (10.32 units vs. 4.77 units, p = 0.014). A small group of patients were disproportionate recipients of transfusions, with approximately 6% of all patients receiving approximately half of the blood products. CONCLUSION: A protocol to limit transfusions decreased the proportion of cardiothoracic surgery patients who received blood products. A very small group of patients received a large number of transfusions, and within that group the observed mortality was significantly higher than in the general patient population. Current protocols cannot possibly account for these patients, and this should be considered when analyzing the performance of protocols designed to reduce unnecessary transfusions.
Authors: Sotiris C Stamou; Tamica White; Scott Barnett; Steven W Boyce; Paul J Corso; Edward A Lefrak Journal: Am J Cardiol Date: 2006-09-07 Impact factor: 2.778
Authors: Aryeh Shander; Axel Hofmann; Sherri Ozawa; Oliver M Theusinger; Hans Gombotz; Donat R Spahn Journal: Transfusion Date: 2009-12-09 Impact factor: 3.157
Authors: Nicole R Guinn; Russell S Roberson; William White; Patricia A Cowper; Bob Broomer; Carmelo Milano; Antonio Chiricolo; Steven Hill Journal: Transfusion Date: 2015-07-16 Impact factor: 3.157
Authors: Elliott Bennett-Guerrero; Yue Zhao; Sean M O'Brien; T B Ferguson; Eric D Peterson; James S Gammie; Howard K Song Journal: JAMA Date: 2010-10-13 Impact factor: 56.272
Authors: Gavin J Murphy; Barnaby C Reeves; Chris A Rogers; Syed I A Rizvi; Lucy Culliford; Gianni D Angelini Journal: Circulation Date: 2007-11-12 Impact factor: 29.690
Authors: Gavin J Murphy; Katie Pike; Chris A Rogers; Sarah Wordsworth; Elizabeth A Stokes; Gianni D Angelini; Barnaby C Reeves Journal: N Engl J Med Date: 2015-03-12 Impact factor: 91.245
Authors: Sharon McCartney; Nicole Guinn; Russell Roberson; Bob Broomer; William White; Steven Hill Journal: Transfusion Date: 2014-05-09 Impact factor: 3.157
Authors: Claude A Beaty; Kara A Haggerty; Madeline G Moser; Timothy J George; Chase W Robinson; George J Arnaoutakis; Glenn J Whitman Journal: Ann Thorac Surg Date: 2013-09-12 Impact factor: 4.330