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[Blood transfusion in heart surgery]
E Fosse1, J L Svennevig, G Semb
1Thoraxkirurgisk seksjon, Kirurgisk avdeling, Oslo.
Insights
Implementing blood-saving measures in open heart surgery significantly reduced donor exposure and costs. Patients experienced a substantial decrease in donor exposure, from 21 to 2, lowering overall operation expenses.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Healthcare Economics
Background:
- Open heart surgery historically involves significant blood product usage.
- Patient exposure to allogeneic blood transfusions carries inherent risks.
- The need for cost-effective surgical practices is paramount in healthcare.
Purpose of the Study:
- To evaluate the impact of implementing blood-saving strategies in open heart surgery.
- To quantify the reduction in blood product exposure and associated costs.
Main Methods:
- Retrospective analysis of fluid administration and blood transfusion data for cardiac surgery patients.
- Data collected over one month in 1986, 1987, and 1988, before and after the introduction of blood-saving measures.
- Key interventions included plasma substitution with polygeline, restrictive thrombocyte transfusion protocols, and a lower hemoglobin threshold for erythrocyte transfusion.
Main Results:
- Median donor exposure per patient decreased from 21 in 1986 to 2 in 1988.
- Postoperative autotransfusion using a retransfusion set was widely implemented by 1988.
- The cost of each open heart operation was reduced by NOK 11,662.
Conclusions:
- Blood-saving measures are effective in reducing allogeneic blood exposure during open heart surgery.
- These strategies lead to significant cost savings per procedure.
- The findings support the broader adoption of blood conservation techniques in cardiac surgery.
Abstract:
We have studied the effect of blood-saving measures in open heart surgery. Such measures were introduced in 1987. All fluids administered on the day of operation and on the first postoperative day were registered in all cardiac patients operated during one month in 1986, 1987, 1988. In 1986 the patients were exposed to a median of 21 donors while in 1988 they were exposed to a median of 2 donors. The reduction in transfusions was achieved by substituting plasma by polygeline, by giving thrombocytes only when there was a low thrombocyte count and by accepting a hemoglobin value of 9 g/100 ml before transfusion of erythrocytes. In 1988 most postoperatively drained blood was retransfused using a Sorensen retransfusion set. The reduction in transfusions has reduced the cost of each open heart operation by NOK 11,662.