The effects of a treatment protocol for cardiac surgical patients with excessive blood loss on clinical outcomes.
Vox Sang
; 91(2): 148-56, 2006 Aug.
Article
em En
| MEDLINE
| ID: mdl-16907876
ABSTRACT
BACKGROUND AND OBJECTIVES:
Excessive blood loss (EBL) is a common complication of cardiac surgery that is associated with adverse events. The objective of this before/after study was to determine whether the implementation of a protocol for management of cardiac surgical patients with EBL was associated with improved clinical outcomes. MATERIALS ANDMETHODS:
In November 2002, a protocol for prompt identification and aggressive management of cardiac surgical patients with EBL was implemented at our institution. The independent relationship between protocol implementation and adverse outcomes was measured by comparing the outcomes of patients who received > or = 4 RBC (red blood cell) units within 1 day of surgery and were operated on before protocol implementation (2000-02) with those operated on after protocol implementation (2003-05), using multivariable logistic regression analysis to control for the effects of confounders. The primary outcome was a composite of adverse events that included death, renal failure, stroke, and sepsis. Bootstrapping was used to confirm the validity of the results.RESULTS:
Of the 11,314 patients who underwent surgery during the study period, 1875 (16.6%) received > or = 4 RBC units within 1 day of surgery, with 958 and 917 in the pre- and postprotocol periods, respectively. The composite adverse outcome occurred in 164 (17.1%) patients in the preprotocol period and 115 (12.5%) patients in the postprotocol period (P = 0.005). Protocol implementation was independently associated with reduced odds of the composite adverse outcome (odds ratio 0.67; 95% confidence interval 0.50, 0.91; P = 0.01). This estimate was stable in bootstrap sampling.CONCLUSION:
Implementation of a protocol to manage EBL in cardiac surgery was independently associated with improved outcomes.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Ponte Cardiopulmonar
/
Protocolos Clínicos
/
Perda Sanguínea Cirúrgica
/
Transfusão de Componentes Sanguíneos
Tipo de estudo:
Guideline
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Vox Sang
Ano de publicação:
2006
Tipo de documento:
Article