Economic impact of inappropriate blood transfusions in coronary artery bypass graft surgery
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Published on: March 23, 2018
Lawrence Tim Goodnough1, R Wida Soegiarso2, John D Birkmeyer3
1From the Department of Medicine and Pathology, Washington University, St. Louis, Missouri USA.
Insights
Unnecessary blood transfusions in coronary artery bypass graft (CABG) surgery account for 27% of all units, costing $96 per patient. Reducing inappropriate transfusions can significantly lower healthcare costs.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Health Economics
Background:
- Blood transfusion practices are influenced by inventory, safety, and cost considerations.
- The financial impact of blood transfusions on healthcare systems is increasingly significant.
- Coronary artery bypass graft (CABG) surgery is a common procedure where blood support is often utilized.
Purpose of the Study:
- To analyze the costs associated with blood support in CABG surgery.
- To quantify the financial impact of unnecessary blood component transfusions in this patient population.
Main Methods:
- A national, multicenter audit of 30 adult patients per institution undergoing primary, elective CABG surgery.
- Review of blood components transfused during the audit.
- Analysis of institutional costs for blood components and inappropriate transfusions.
Main Results:
- Significant institutional variation in blood purchase costs (over two-fold) and transfusion volumes (red cells over 10-fold, total components over 40-fold).
- Unnecessary transfusions constituted 27% of all blood units, ranging from 7% to 43% across institutions.
- Inappropriate transfusions represented 47% of platelets, 32% of plasma, and 15% of red cells transfused, costing $96 per patient.
Conclusions:
- A substantial proportion of blood components transfused during CABG surgery are unnecessary.
- Inappropriate transfusions represent a significant, avoidable cost in cardiovascular surgery.
- Implementing practice guidelines and quality improvement programs can reduce unnecessary transfusions and associated costs.
Purpose:
In addition to historically important issues of blood inventory and blood safety, the costs of blood transfusion are anticipated to have an increasingly important impact on transfusion practices. To address this, we analyzed costs of blood support given to patients undergoing coronary artery bypass graft (CABG) surgery, along with costs of blood components whose transfusions were identified to be unnecessary.
Patients And Methods:
Blood components transfused as part of a previously reported national, multicenter audit of 30 adult patients each at 18 institutions undergoing primary, elective CABG surgery were reviewed.
Results:
The range of blood purchase costs among institutions was broad, varying over two-fold. The range of red cell units transfused varied over 10-fold, and the range of total components transfused varied over 40-fold. The number of blood components transfused unnecessarily represented 27% of all blood units transfused, ranging from 7% to 43% among institutions. Inappropriate transfusions accounted for 47%, 32%, and 15% of all platelet, plasma, and red cell units transfused. The mean institutional cost for all blood components transfused per patient was $397 +/- $244. The cost per patient of components transfused inappropriately was 24% of this, or $96 +/- $89 (mean +/- SD).
Conclusion:
These costs could be reduced with practice guidelines and quality improvement programs aimed at reducing the number of inappropriate transfusions.
