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Improvements in patient blood management for pediatric craniosynostosis surgery using a ROTEM(®) -assisted strategy -
Thorsten Haas1, Susan Goobie, Nelly Spielmann
1Department of Anaesthesia, University Children's Hospital Zurich, Zurich, Switzerland.
Insights
Implementing a ROTEM(®)-assisted patient blood management (PBM) strategy significantly reduced intraoperative bleeding and transfusion costs in pediatric craniosynostosis surgery. This approach avoided fresh frozen plasma transfusions and lowered overall expenses.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Transfusion Medicine
Background:
- Intraoperative bleeding and coagulopathy are significant challenges in pediatric craniosynostosis repair.
- Existing management strategies may not fully address these complications.
- A novel approach using ROTEM(®)-assisted patient blood management (PBM) was investigated.
Purpose of the Study:
- To analyze the feasibility and cost-effectiveness of a ROTEM(®)-assisted PBM strategy.
- To evaluate the impact of this PBM strategy on transfusion requirements.
- To assess the direct costs associated with transfusion and coagulation factor concentrates.
Main Methods:
- Retrospective analysis of pediatric patients undergoing craniosynostosis repair (2007-2013).
- Comparison of laboratory workup and transfusion requirements between a historic group and a group managed with PBM.
- Implementation of a PBM strategy guided by ROTEM(®) (Rotational Thromboelastometry) parameters.
Main Results:
- Allogeneic red blood cell transfusions were still necessary.
- Perioperative fresh frozen plasma transfusions were completely avoided.
- Platelet transfusions were reduced, and fibrinogen concentrate was administered based on ROTEM(®) thresholds.
- Mean total costs per patient decreased by 17.1% after PBM implementation.
Conclusions:
- ROTEM(®)-assisted PBM is a feasible strategy for major pediatric craniosynostosis surgery.
- This PBM approach significantly reduces intraoperative transfusion requirements.
- Implementation of ROTEM(®)-assisted PBM leads to a considerable decrease in transfusion-related direct costs.
Background:
Moderate to severe intraoperative bleeding and the presence of acquired coagulopathy remain serious problems in the management of major pediatric craniosynostosis surgery. After implementation of a ROTEM(®) -assisted patient blood management (PBM) strategy, using primarily purified coagulation factor concentrates, feasibility and costs of this new regimen were analyzed.
Methods:
Retrospective analysis of all consecutive children who underwent primary elective major craniofacial surgery for craniosynostosis repair was carried out at the Children's University Hospital, Zurich, between 2007 and 2013. Laboratory workup and transfusion requirements were compared.
Results:
A total of 47 children (36 in the historic group and 11 after implementation of PBM) were analyzed. Although all patients in this study needed transfusion of red blood cell concentrates, there was a total avoidance of perioperative transfusion of fresh frozen plasma and a reduction in transfused platelets (one of nine children vs nine of 36 children in the historic group) after implementation of the PBM strategy. Based on a predefined ROTEM(®) threshold in the PBM group (FibTEM MCF <8 mm), administration of fibrinogen concentrate was necessary in all of these children. The mean total costs per patient consisting of transfused allogeneic blood products and coagulation factor concentrates were reduced by 17.1% after implementation of PBM (1071.82 EUR per patient before vs 888.93 EUR after implementation).
Conclusions:
The implementation of a ROTEM(®) -assisted PBM is feasible and is associated with a considerable reduction in intraoperative transfusion requirements and thereby a decrease in transfusion-related direct costs.
