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[Bedside thrombelastography. Cost reduction in cardiac surgery]

G J Spalding1, M Hartrumpf, T Sierig

  • 1Herzchirurgie, Herzzentrum Brandenburg, Ladeburger Strasse 17, 16321 Bernau bei Berlin. g.spalding@immanuel.de

Der Anaesthesist
|May 23, 2007
PubMed

Insights

Implementing bedside rotational thromboelastometry (ROTEM) significantly reduced blood product costs in cardiac surgery. This cost-effective approach improved coagulation management and decreased overall expenditure.

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.
Abstract

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