Patient blood management in cardiac surgery results in fewer transfusions and better outcome

BackgroundThe aim of this study was to investigate the impact of the introduction of a patient blood management (PBM) program in cardiac surgery on transfusion incidence and outcome. Study Design and MethodsClinical and transfusion data were compared between the pre-PBM epoch (July 2006-March 2007) and the PBM epoch (April 2007-September 2012). ResultsThere were a total of 2662 patients analyzed, 387 in the pre-PBM and 2275 in the PBM epoch. Red blood cell (RBC) loss decreased from a mean (SD) of 810 +/- 426mL (median, 721mL) to 605 +/- 369mL (median, 552mL; p<0.001) and pretransfusion hemoglobin decreased from 7.2 +/- 1.4to 6.6 +/- 1.2g/dL (p<0.001) in the pre-PBM versus the PBM epoch. In conjunction, this resulted in a reduction of the RBC transfusion rate from 39.3% to 20.8% (p<0.001). Similar reductions were observed for the transfusion of fresh-frozen plasma (FFP; from 18.3% to 6.5%, p<0.001) and platelets (PLTs; from 17.8% to 9.8%, p<0.001). Hospital mortality and cerebral vascular accident incidence remained unchanged in the PBM epoch. However, the incidence of postoperative kidney injury decreased in the PMB epoch (from 7.6% to 5.0%, p=0.039), length of hospital stay decreased from 12.2 +/- 9.6 days (median, 10 days) to 10.4 +/- 8.0 days (median, 8 days; p<0.001), and total adjusted direct costs were reduced from $48,375 +/-$28,053 (median, $39,709) to $44,300 +/-$25,915 (median, $36,906; p<0.001). ConclusionsImplementing meticulous surgical technique, a goal-directed coagulation algorithm, and a more restrictive transfusion threshold in combination resulted in a substantial decrease in RBC, FFP, and PLT transfusions; less kidney injury; a shorter length of hospital stay; and lower total direct costs.