Thrombelastography-Directed Transfusion in Cardiac Surgery: Impact on Postoperative Outcomes

Area of Science:

• Cardiovascular Surgery
• Transfusion Medicine
• Critical Care Medicine

Background:

• Allogeneic blood transfusions increase morbidity and mortality risks.
• Thromboelastography (TEG) was implemented to guide transfusion management post-cardiothoracic surgery.
• Reduced blood product usage was observed institutionally after TEG implementation.

Purpose of the Study:

• To quantify the impact of TEG on postoperative outcomes in cardiac surgical patients.
• To assess changes in blood product administration and patient outcomes after TEG adoption.
• To evaluate TEG's effect on reoperation, length of stay, and mortality.

Main Methods:

• Retrospective analysis of cardiac surgical patients before and after TEG implementation.
• Comparison of baseline characteristics, blood product administration, and length of stay (LOS).
• Logistic regression used to evaluate TEG's impact on reoperation, LOS, and 6-month mortality.

Main Results:

• 367 patients in the pre-TEG period and 310 in the post-TEG period were analyzed.
• Blood product exposure significantly decreased post-TEG implementation (p < 0.001).
• Lower reoperation rates (7.1% vs 3.5%, p=0.04), reduced LOS (11.3 vs 9.9 days, p=0.04), and decreased 6-month mortality (OR 2.98) were observed with TEG.

Conclusions:

• TEG significantly improved patient outcomes, including LOS, reoperation odds, and short-term mortality.
• Reduced allogeneic blood product use and improved differentiation of coagulopathy vs. surgical bleeding likely contributed to positive outcomes.
• TEG is a valuable point-of-care tool for optimizing transfusion management and patient recovery in cardiothoracic surgery.