[Bedside thrombelastography. Cost reduction in cardiac surgery].

Area of Science:

• Cardiovascular Surgery
• Anesthesiology
• Transfusion Medicine

Background:

• Increasing costs of blood and coagulation products in cardiac surgery due to demographic changes and antiplatelet medication.
• Need for effective strategies to manage perioperative coagulation and control expenditure.

Purpose of the Study:

• To evaluate the cost-effectiveness of bedside rotational thromboelastometry (ROTEM) in cardiac surgery.
• To analyze the impact of ROTEM on the use of blood products and coagulation factors.
• To develop a cost-effective treatment algorithm for perioperative coagulation disorders.

Main Methods:

• Retrospective analysis of annual treatment costs for cardiosurgical patients before and after ROTEM implementation.
• Assessment of cumulative numbers and costs of platelet concentrates (PltC), fresh frozen plasma (FFP), red blood cell units (RBC), and coagulation factors (PCC, rFVIIa, FXIII, fibrinogen).
• Comparison of average monthly costs, rethoracotomies, and early mortality between the two periods.

Main Results:

• ROTEM implementation led to a 25% decrease in RBC and 50% decrease in PltC expenditure.
• Significant reductions in prothrombin complex concentrates (PCC) and factor XIII (FXIII) by 80%, with complete omission of rFVIIa.
• Overall blood product costs decreased by 32% and coagulation factor costs by 50%, resulting in combined savings of 44%, outweighing ROTEM expenses.
• Rethoracotomies decreased from 6.6% to 5.5%, while early mortality remained stable.

Conclusions:

• Bedside ROTEM analysis enables selective substitution management, significantly reducing costs for perioperative coagulation disorders.
• Cost savings from reduced blood and coagulation product use substantially exceed ROTEM implementation costs.
• Differential coagulation management guided by ROTEM is a cost-effective strategy in cardiac surgery.