Economic aspects of intraoperative coagulation management targeting higher fibrinogen concentrations during major craniosynostosis surgery

Area of Science:

• Anesthesiology
• Pediatric Surgery
• Transfusion Medicine

Background:

• Previous study showed reduced transfusion needs and blood loss in pediatric craniosynostosis surgery using a higher ROTEM(®) FIBTEM trigger (<13 mm) versus a conventional trigger (<8 mm).
• This study performed a posthoc cost analysis of coagulation management based on the prior findings.

Purpose of the Study:

• To evaluate the economic impact of different fibrinogen trigger levels on coagulation management costs in pediatric craniosynostosis surgery.
• To determine if a higher fibrinogen trigger is associated with increased expenditure for blood products and coagulation factors.

Main Methods:

• Collected data on transfusion volumes, units of blood products, and coagulation factors for each patient.
• Analyzed the number of laboratory and point-of-care coagulation tests performed.
• Calculated total blood product costs using local unit prices.

Main Results:

• Median costs for blood products/coagulation factors were 1023EUR (early substitution group) versus 910EUR (conventional group), with no statistically significant difference (P = 0.81).
• No significant variation was observed in the number of coagulation tests administered between the groups.

Conclusions:

• Employing a higher fibrinogen trigger level in this cohort did not lead to a significant rise in overall costs for transfused blood products and coagulation factors.
• This higher trigger strategy represents a potentially cost-neutral alternative for coagulation management in pediatric major craniosynostosis surgery.