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[Results of implementation of a perioperative Patient Blood Management program in cardiovascular surgery]
F Martínez Jiménez1, I Fornet Ruíz1, A I Peral García1
1Servicio de Anestesiología y Reanimación Hospital Universitario Puerta del Hierro Majadahonda, Madrid, España.
Insights
Patient Blood Management (PBM) programs effectively reduce allogeneic blood transfusions in cardiac surgery patients. This approach lowers infection rates and costs without negatively impacting patient outcomes, demonstrating its value in complex care settings.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Critical Care Medicine
Background:
- Cardiovascular surgery patients frequently experience perioperative anemia and bleeding, leading to high rates of allogeneic blood transfusion (AST).
- AST is linked to increased morbidity, mortality, and prolonged hospital stays.
- Patient Blood Management (PBM) programs offer a strategy to mitigate unnecessary transfusions.
Purpose of the Study:
- To implement a PBM program in cardiac surgery.
- To reduce allogeneic blood transfusion rates.
- To maintain or improve patient outcomes (morbidity, mortality, length of stay) and cost-effectiveness.
Main Methods:
- A mixed cohort study involving 226 patients.
- Comparison of a retrospective pre-PBM group (2016) with a prospective intervention group (2018) post-PBM implementation.
- Analysis of transfusion rates, clinical outcomes, and costs.
Main Results:
- Significant reduction in allogeneic blood transfusion (AST) from 92.59% to 79.69% (P<.001).
- Decreased incidence of fever (12.35% vs 1.56%, P=.006) and reduced need for antibiotic escalation (64.8% vs 42.19%, P=.002).
- Average length of stay reduced by 3.6 days (P=.18); cost savings of €163.29 per patient.
Conclusions:
- PBM programs are effective in reducing AST in high-complexity cardiac surgery patients.
- Evidence suggests PBM may decrease infections and potentially shorten hospital stays and mortality.
- The PBM intervention proved cost-effective, with savings exceeding implementation costs.
Background And Objective:
Cardiovascular surgery (CCV) patients have a high incidence of perioperative anemia and bleeding that determines a high rate of allogeneic blood transfusion (AST). This is associated with an increase in morbidity, mortality and prolongs length of stay in hospital. Unnecessary transfusion is one of the measures to avoid and Patient Blood Management (PBM) programs have proven their effectiveness. Our objective was to reduce the transfusion of patients in cardiac surgery, without inferior results in morbidity and mortality, length of stay in hospital and being cost-effective, through the implementation of a PBM program.
Material And Methods:
A mixed cohort study of 226 patients divided into 2 groups: retrospective pre-PBM (GP), from 2016, and intervention group (IG), prospective from 2018, with the results of the implementation of the guide.
Results:
The clinical results obtained allowed reducing the TSA from 92.59% to 79.69% (P<.001), saving 2.59 units of CH and 2.5 of PFC per patient (P<.001). A decrease was found in patients with fever (12.35% vs 1.56% with P=.006) and the need to escalate antibiotics (64.8% vs 42.19%, P=.002). The rest of postoperative complications and mortality at 3months did not present statistically significant differences. The length of stay was reduced by an average 3.6days in the IG, (95%CI: -8.10 to 0.9, P=.18). The cost decreased by 163.29€ per patient, taking into account exclusively the saving of blood components.
Conclusion:
The PBM program is effective in reducing TSA in cardiac surgery in a tertiary hospital with high complexity patients and high transfusion rate. There are signs suggestive of a decrease in infections and a tendency to decrease the length of stay and mortality. In the economic approximation carried out, the cost of the intervention was lower than the savings implied by the decrease in transfusion.
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