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A structured blood conservation programme reduces transfusions and costs in cardiac surgery
Lisa Ternström1, Monica Hyllner2, Erika Backlund3
1Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Insights
Implementing a structured blood conservation program in cardiac surgery significantly reduced blood product transfusions and associated costs. This initiative maintained patient safety, with no increase in complications or mortality, and the positive effects persisted for at least three years.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Healthcare Management
Background:
- Blood product transfusions, while life-saving, carry risks like immune responses and infections.
- In cardiac surgery, transfusions are linked to increased patient mortality.
- A need exists for strategies to mitigate transfusion risks and costs in this patient population.
Purpose of the Study:
- To prospectively evaluate the impact of a structured blood conservation program on transfusion rates and costs in cardiac surgery.
- To assess the safety of cardiac surgery patients during and after the implementation of the program.
- To determine the long-term sustainability of the program's effects.
Main Methods:
- A comprehensive program involving staff education, revised transfusion guidelines, and a detailed transfusion log was implemented.
- Transfusion prevalence, complications, and costs were compared for 1128 patients before and 1034 patients after program initiation.
- Data collection continued for an additional two years post-implementation.
Main Results:
- Red blood cell concentrate transfusions decreased by 21.8%, plasma by 37.4%, and platelets by 21.0% in the first year.
- No significant differences were observed in reoperations for bleeding, early complications, or 30-day mortality.
- First-year savings on blood products amounted to €161,623, with sustained reductions in transfusion rates up to three years post-program initiation.
Conclusions:
- A structured blood conservation program effectively reduces blood product transfusions and costs in cardiac surgery.
- The program demonstrated no compromise in patient safety, maintaining comparable complication and mortality rates.
- The benefits of the blood conservation program were sustained for at least three years.
Objectives:
Transfusions of blood products can be lifesaving, but they are also associated with considerable risks and adverse effects, including immune response and infections. In cardiac surgery, transfusions have also been associated with increased mortality. We prospectively studied the effects of a structured programme to reduce transfusions and transfusion-associated costs in cardiac surgery.
Methods:
The programme included: (i) education of all staff about the risks and benefits of blood transfusions; (ii) revised guidelines for transfusions; and (iii) a transfusion log where indication for transfusion, status of the patient and prescribing physician were registered. Transfusion prevalence, complications and costs for blood products were registered for all acute and elective cardiac operations during a 12-month period before (n = 1128) and after (n = 1034) the programme was started. The two time periods were compared. In addition, the prevalence of transfusions was registered for 2 more years after the programme was initiated.
Results:
The first year after the programme was initiated the proportion of patients transfused with red blood cell concentrate decreased by 21.8% (from 58.2 to 45.5%, P <0.001), plasma by 37.4% (from 30.8 to 19.3%, P <0.001) and platelets by 21.0% (from 20.5 to 16.2%, P = 0.010). Reoperations for bleeding (5.8 vs 5.0%), early complication rate and 30-day mortality (2.5 vs 2.6%) were not significantly different before and after the start date. Based on the 2009 institutional prices for red blood cell concentrate (102 €/unit), plasma (35 €/unit) and platelets (290 €/unit), the savings on blood products were €161,623 during the first 12 months after the programme was launched. The proportion of patients transfused with any blood product was 60.9% before the programme was started and 48.3, 54.0 and 50.7% 1-3 years after its start (all P <0.001), respectively.
Conclusions:
A structured blood conservation programme reduces transfusions and costs for blood products in cardiac surgery, without any signs of compromised medical safety. The effects of introducing such a programme are maintained over at least 3 years.
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