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Intra-operative autologous blood donation for cardiovascular surgeries in Japan: A retrospective cohort study
Takuya Okuno1, Susumu Kunisawa1, Kiyohide Fushimi2
1Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Insights
Intra-operative autologous blood donation significantly reduced red blood cell transfusion rates and amounts in Japanese cardiovascular surgery patients. This blood conservation technique proved effective for both cardiac and aortic surgeries.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Health Services Research
Background:
- Intra-operative autologous blood donation (iABD) is a blood conservation strategy with limited evidence.
- Its effectiveness in reducing peri-operative transfusions in cardiovascular surgery requires further investigation.
Purpose of the Study:
- To evaluate the association between iABD and decreased peri-operative transfusion in cardiovascular surgery.
- To analyze transfusion rates and volumes in cardiac and aortic surgeries using a Japanese administrative database.
Main Methods:
- Utilized data from the Japanese Diagnosis Procedure Combination database (2016-2019).
- Employed multilevel propensity score matching to compare iABD and control groups in cardiac and aortic surgeries.
- Analyzed red blood cell (RBC) and fresh frozen plasma (FFP) transfusion data.
Main Results:
- iABD was associated with significantly lower RBC transfusion rates in both cardiac (60.6% vs 38.4%) and aortic surgery (91.4% vs 83.8%) cohorts.
- Transfusion volumes were reduced in the iABD group for cardiac (5.9 vs 3.5 units) and aortic surgeries (11.9 vs 7.9 units).
- Significant reductions in transfusion rates and amounts were observed for RBC and FFP.
Conclusions:
- Intra-operative autologous blood donation is an effective blood transfusion strategy for Japanese cardiovascular surgery patients.
- iABD can reduce the need for allogeneic blood products in both cardiac and aortic procedures.
- This study supports the implementation of iABD as a blood conservation measure in cardiovascular surgery.
Abstract:
Intra-operative autologous blood donation is a blood conservation technique with limited evidence. We evaluated the association between intra-operative autologous blood donation and decrease in peri-operative transfusion in cardiovascular surgery based on evidence from a Japanese administrative database. We extracted the data of patients who had undergone cardiovascular surgery from the Diagnosis Procedure Combination database in Japan (2016-2019). Based on the surgery type, we examined the association of intra-operative autologous blood donation with the transfusion rate and amount of blood used in cardiac and aortic surgeries using multilevel propensity score matching. We enrolled 32,433 and 4,267 patients who underwent cardiac and aortic surgeries and received 5.0% and 6.7% intra-operative autologous blood donation with mean volumes of 557.68 mL and 616.96 mL, respectively. The red blood cell transfusion rates of the control and intra-operative autologous blood donation groups were 60.6% and 38.4%, respectively, in the cardiac surgery cohort (p < .001) and 91.4%, and 83.8%, respectively, in the aortic surgery cohort (p = .037). The transfusion amounts for the control and intra-operative autologous blood donation groups were 5.9 and 3.5 units of red blood cells, respectively, for cardiac surgery patients (p < .001) and 11.9 and 7.9 units, respectively, for aortic surgery patients (p < .001). Intra-operative autologous blood donation could reduce the transfusion rate or amount of red blood cells and fresh frozen plasma for patients undergoing index cardiovascular surgery and could be an effective blood transfusion strategy in cardiovascular surgery for Japanese patients.
