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- Title
Patient blood management in cardiac surgery results in fewer transfusions and better outcome.
- Authors
Gross, Irwin; Seifert, Burkhardt; Hofmann, Axel; Spahn, Donat R.
- 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.
- Subjects
CARDIAC surgery; BLOOD transfusion; BLOOD circulation; HEALTH outcome assessment; DISEASE incidence
- Publication
Transfusion, 2015, Vol 55, Issue 5, p1075
- ISSN
0041-1132
- Publication type
Article
- DOI
10.1111/trf.12946