This retrospective study indicates that, in addition to RBC, platelet transfusions are an independent risk factor for survival after OLT. These findings have important implications for transfusion practice in liver transplant recipients.

During the recent years improved operation techniques and administrative procedures have been developed for early rehabilitation. At the same time preoperative lifestyle intervention (prehabilitation) has revealed a large potential for additional risk reduction.The aim was to assess the quality of life and to estimate the cost-effectiveness of standard care versus an integrated programme including prehabilitation and early rehabilitation.MethodsThe analyses were based on the results from 60 patients undergoing lumbar fusion for degenerative lumbar disease; 28 patients were randomised to the integrated programme and 32 to the standard care programme.Data on cost and health related quality of life was collected preoperatively, during hospitalisation and postoperatively. The cost was estimated from multiplication of the resource consumption and price per unit.ResultsOverall there was no difference in health related quality of life scores. The patients from the integrated programme obtained their postoperative milestones sooner, returned to work and soaked less primary care after discharge. The integrated programme was 1,625€ (direct costs 494€ + indirect costs 1,131€) less costly per patient compared to the standard care programme.ConclusionThe integrated programme of prehabilitation and early rehabilitation in spine surgery is more cost-effective compared to standard care programme alone.

IntroductionIn general surgery and in spinal surgery, allogeneic blood transfusions (ABT) have been related to increased post-operative complications [12,13, 37, 39]. As such, reduction in ABT is a high priority in spinal surgery. Recently, techniques to reduce the need for ABT during spinal surgery have surfaced in the orthopedic surgery literature.Understanding the risk factors and costs associated with ABT can help with the discovery of new costeffective methods to reduce its burden. Several possible methods of reducing blood loss and the need for ABT associated with spinal fusion surgery currently exist. These include use of autologous pre-donation of blood [7,11,16,26, 31, 32, 40], blood dilution techniques [4,10,14,15,19,22], erythropoietin [24], use of antifibrinolytics [1,8,9,20,24,27, 30, 34, 35, 41], and use of cell salvage [6, 33]. Prior research on techniques used to reduce the need for ABT has previously been conducted in single-site hospitals or in a small number of patients enrolled in a clinical trial, which does not accurately provide a clear picture of the utilization and cost burden associated with it. The literature has not been able to provide an illustration of the current state of the use and cost of ABT in the US population.

Based on the outcomes observed in the RE-LY trial, dabigatran represents a cost-effective alternative to warfarin in Denmark for all patients with atrial fibrillation within the licensed indication of dabigatran.

This article assesses the use and costs of blood transfusion during knee and hip surgery through a retrospective observational study of 92,223 discharged inpatients who had undergone knee or hip surgery from July 1, 2003, through June 30, 2004; a sample of US hospitals that participated in the Perspective Comparative Database (Premier Inc., Charlotte, NC) was used. Descriptive and multivariate analyses were performed to determine the use and costs of allogeneic blood transfusion (ABT). The average cost of ABT per user ranged from $387 (SD=$952) for red blood cells to $6585 (SD=$11,162) for cryoprecipitate. Utilization rates in the sample were as follows: antifibrinolytics, 0.14%; topical sealants, 3.24%; volume expanders, 3.89%; erythropoietin agents, 5.08%; and hypotensive anesthesia, 22.28%. Patients who were given volume expanders ($133.73, SD=$23.00, P<.01) or erythropoietin ($177.72, SD=$34.61, P<.01) had higher costs associated with ABT than did those who did not use volume expanders or erythropoietin. Patients who received hypotensive anesthesia (odds ratio [OR]=1.96; 95% confidence interval [CI], 1.87-2.06), a volume expander (OR=1.71; 95% CI, 1.57- 1.85), a topical sealant (OR=1.61; 95% CI, 1.45-1.79), or an erythropoietic agent (OR=2.30; 95% CI, 2.06-2.57) had a greater likelihood of ABT. Investigators concluded that most transfusion reduction techniques are underused, or they do not reduce the burden of ABT associated with knee or hip surgery.