ABSTRACT
BACKGROUND: Mounting evidence exists for more restrictive blood transfusion practices in patients undergoing cardiac surgery. Few studies, however, have recognized or agree upon a method by which this decrease in allogeneic red blood cell transfusion can be achieved. We will review our methods and experience in a blood conservation initiative from 2003 to 2007. METHODS: A data driven, multidisciplinary effort to decrease allogeneic red blood cell transfusion was instituted in a community hospital. Numerous innovations in treatment protocols were implemented and evaluated. Clinical data from 2003 to 2007 will be presented. Yearly review of outcomes led to an evolving clinical practice and lowered transfusion rates. RESULTS: A total of 2,531 consecutive cardiac surgical procedures were performed during a five-year period. Using a multidisciplinary approach to quality improvement, and with the goal of using fewer blood products, our incidence of allogeneic red blood cell transfusion was decreased, from 43% in 2003 to 18% in 2007. Patient outcomes were not significantly changed. CONCLUSIONS: Cardiac surgery in a community hospital can be performed safely with low utilization of allogeneic red blood cell transfusions. A multidisciplinary approach to blood conservation can result in lower transfusion rates and equivalent patient outcomes.
Subject(s)
Blood Transfusion, Autologous/statistics & numerical data , Cardiac Surgical Procedures/statistics & numerical data , Hospital Mortality/trends , Aged , Blood Transfusion, Autologous/adverse effects , Cardiac Surgical Procedures/methods , Cardiac Surgical Procedures/mortality , Cohort Studies , Confidence Intervals , Erythrocyte Transfusion/adverse effects , Erythrocyte Transfusion/statistics & numerical data , Female , Follow-Up Studies , Health Care Surveys , Hospitals, Community , Humans , Interdisciplinary Communication , Male , Middle Aged , Odds Ratio , Perioperative Care , Postoperative Complications/mortality , Probability , Registries , Retrospective Studies , Risk Assessment , Safety Management , Survival AnalysisABSTRACT
Previous studies have shown that minimizing the amount of hemodilution during open-heart surgery reduces the need for a blood transfusion. Transfusion increases a patient's medical risks and leads to increased costs. We used a shortened bypass circuit, primed with autologous blood in a retrograde fashion, to decrease red cell transfusion in high-risk patients. One hundred twenty-three patients having first-time, nonemergent coronary artery surgery were chosen for this trial, based on their low prebypass hematocrit and weight. In seventy-two cases, we used a shortened bypass circuit and retrograde autologous prime. A historical control group of fifty-one patients received a standard bypass circuit and prime method. The prebypass hematocrit was 35 +/- 2.62% and 34 +/- 2.99% in the control and study groups, respectively. Red blood cell transfusion was necessary in 70% of the control group during their hospital stay, whereas only 51.4% of the study group required transfusion (p = .006). Patients receiving no blood products were significantly higher in the study group, 48.6% vs. 30.0% (p = .005). The postbypass hematocrit was similar at 26.5 +/- 1.82% vs. 25.5 +/- 2.38%, and the discharge hematocrit was 30.8 +/- 3.33% and 31.2 +/- 3.04% in the control and study groups. respectively. Minimizing hemodilution by shortening the bypass circuit and performing retrograde autologous prime conserves the use of blood during routine coronary artery bypass surgery. These methods can be used for patients who are at greater risk for transfusion.