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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

Summary

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

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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.