Implementing a protocol to optimize blood use in a cardiac surgery service: results of a pre‐post analysis and the impact of high‐volume blood users

Abstract

Background Blood transfusions are a common and costly intervention for cardiac surgery patients. Evidence suggests a more restrictive transfusion strategy may reduce costs and transfusion-related complications without increasing perioperative morbidity and mortality. Study design and methods A transfusion-limiting protocol was developed and implemented in a cardiovascular surgery unit. Over a 5 year period, data were collected on patient characteristics, procedures, utilization of blood products, morbidity and mortality, and these were compared before and after the protocol was implemented. Results After the protocol was put in place, fewer patients required transfusions (38.2% vs 45.5%, p=0.004), with the greatest reduction observed in post-operative blood use (29.1% vs 37.2%, p=0.001). In-hospital morbidity and mortality did not increase. When transfused patients were stratified by procedure, the protocol was most effective in reducing transfusions for patients undergoing isolated coronary artery bypass grafting (4.09 vs 2.51 units, p=0.009) and coronary artery bypass grafting plus valve surgery (10.32 vs 4.77 units, p=0.014). A small group of patients were disproportionate recipients of transfusions, with approximately 6% of all patients receiving about half of the blood products. Conclusion A protocol to limit transfusions decreased the proportion of cardiothoracic surgery patients who received blood products. A very small group of patients received a large number of transfusions, and within that group the observed mortality was significantly higher than in the general patient population. Current protocols cannot possibly account for these patients, and this should be considered when analyzing the performance of protocols designed to reduce unnecessary transfusions.

Use of factor concentrates for the management of perioperative bleeding: reply

“…4. We fully agree with Sargant et al and with the authors of many studies [8][9][10][11][12] and guidelines [7] that a protocol for surgical blood loss management with clear objectives can help the team to focus on specific tasks and can facilitate a rapid response. Such a protocol should incorporate predefined triggers and targets to guide individualized hemostatic interventions.…”

Comparison of the Surgical Effect and the Long-term Clinical Outcomes Between Robotic and Sternotomy Mitral Valve Replacement

“…Considering the obvious clinical effects, the main reason for these ndings is that robotic surgery obviates the need to disrupt the sternum and reduces complications associated with sternotomy. In addition to pain relief during postoperative recovery, robotic surgery is associated with considerable reduced blood loss and blood product transfusion, which can also minimize the possibility of transfusion-related acute lung injury, infection and allergy [18]. In principle, the use of blood products should be minimized to ensure clinical safety.…”