Reduction in Costs, Blood Products, and Operating Time in Patients Undergoing Open Heart Surgery

Lazzara, Robert R.; Kidwell, Francis E; Kraemer, Michael; Wood, J. V.; Starr, Albert

doi:10.1001/archsurg.1997.01430320060009

Cited by 18 publications

(7 citation statements)

References 9 publications

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“…This is in contrast to corresponding economic studies in cardiac surgery patients [11,12,19,20]. These studies demonstrate aprotinin not only efficacious in reducing blood loss and effective in reducing allogeneic blood transfusion but also to be a cost-effective adjunct pharmacological intervention, especially when low-dose aprotinin is applied [12,19]. In the study of Baele et al [11], cost savings by aprotinin amounted to approximately 9% of the hospital bill which is far greater than savings in our orthopedic patients with approximately 2%.…”

Section: Discussioncontrasting

confidence: 77%

“…To our knowledge, no paper has yet been published that analyzes cost data for transfusion-related cost of aprotinin administration in patients undergoing infectious orthopedic surgery. This is in contrast to corresponding economic studies in cardiac surgery patients [11,12,19,20]. These studies demonstrate aprotinin not only efficacious in reducing blood loss and effective in reducing allogeneic blood transfusion but also to be a cost-effective adjunct pharmacological intervention, especially when low-dose aprotinin is applied [12,19].…”

Section: Discussionmentioning

confidence: 67%

“…Besides cardiac surgery, positive results with respect to reduction of blood loss have also been reported for orthopedic surgery [3][4][5][6][7][8] as well as partially for liver surgery [9] and peripheral vascular surgery [10]. In contrast to cardiac surgery patients [11][12][13], no cost-efficiency analysis of adjunct aprotinin application in orthopedic surgery patients has been published so far. In our institution, major one-step infected revision arthroplasty of large joints, which is associated with blood losses between 5 and (sometimes even more than) 10 l, has been established for more than one decade.…”

Section: Introductionmentioning

confidence: 99%

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Transfusion-Related Cost of Adjunct Aprotinin Application in One-Step Infected Hip Revision Arthroplasty – Cost-Minimizing Analysis

Singbartl¹,

Kantak²,

Munkel³

2001

Transfus Med Hemother

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Objective: Cost-minimizing analysis (CMA) on adjunct aprotinin application in infected hip revision arthroplasty in a private hospital, specialized in major bone and joint surgery. Patients and Methods: Retrospective (without aprotinin) / prospective (with aprotinin) study in 114 consecutive patients (57 patients in each group), undergoing one-step infected hip revision arthroplasty. After H1/H2 blockade, patients in the aprotinin group received a bolus infusion of 1.5 million kallikrein-inhibiting units (KIU) aprotinin (Trasylol(r)) followed by 500,000 KIU/h for the first 3 h and then 250,000 KIU until the end of operation. Blood loss was estimated by the hematocrit (Hct) method at prefixed times and is given as loss of red blood cell (RBC) mass. Cost data consider acquisition cost of autologous and allogeneic blood products from commencing surgery until discharge and additionally include cost for cross-matching and screening, drugs for H1/H2 blockade, aprotinin, consumables, administration sets until discharge, and volume substitution with crystalloid and colloids until the first postoperative day (POD 1). Statistical analysis included, according to Gaussian/non-Gaussian distribution, t-test/U-test for comparison of means ?(?SD) of continuous variables, and chisquare test for analysis of categorical variables. Statistical significance was considered if p < 0.05. Results: There were no differences between the two groups concerning age, sex, type of anesthesia, estimated blood volume, initial Hct, Hct at discharge, number of autologous units predonated, surgery time, length of stay both on ICU and in hospital. Aprotinin reduced loss of RBC mass by approximately 31% (from 2.9 ???.9 to 2.0 ? 1.1 l; p = 0.001), number of RBC units transfused per patient (from 7.4 ? 5.3 to 4.9 ??3.3 U; p = 0.001), and number of fresh frozen plasma units administered per patient (from 5.1 ??5.2 to 1.7 ??2.8 U; p << 0.001). Transfusion-related cost in aprotinin patients were reduced by approximately 42% (p << 0.001; from EUR 742 ??576 to EUR 431 ??326). Infusion- together with transfusion-related cost in aprotinin patients were by 27.2% lower (EUR 586 ??331) than in control patients (EUR 805 ??592; p = 0.006). Conclusion: This CMA on aprotinin administration in one-step infected hip revision arthroplasty demonstrates that this drug is beneficial for both the patient and the hospital. Aprotinin decreased RBC loss, reduced transfusion of allogeneic blood products, and thereby showed a positive pharmacoeconomic profile for the hospital budget.

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Section: Discussioncontrasting

confidence: 77%

Section: Discussionmentioning

confidence: 67%

Section: Introductionmentioning

confidence: 99%

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Transfusion-Related Cost of Adjunct Aprotinin Application in One-Step Infected Hip Revision Arthroplasty – Cost-Minimizing Analysis

Singbartl¹,

Kantak²,

Munkel³

2001

Transfus Med Hemother

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“…The economic analyses suggesting greater cost savings with low-dose aprotinin regimens must be tempered with the questionable effectiveness of these regimens for substantially reducing transfusion requirements and repeat surgery rates. 27,28,35 There are other considerations that must be taken into account when evaluating these economic studies. For example, the investigators did not consider possible differences in reoperation rates for bleeding, myocardial infarction, or stroke.…”

Section: Hemostatic Agents In Cardiac Surgerymentioning

confidence: 99%

Antifibrinolytic Agents and Desmopressin as Hemostatic Agents in Cardiac Surgery

Erstad¹

2001

Ann Pharmacother

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“…They found that, of the two, using low dose aprotinin generated the most striking cost savings, despite being less clinically effective than the high dose alternative. Furthermore, Able and Tilly [25] found that low dose aprotinin for repeat CABG surgery saved US$1516 compared to non-treated patients; others concurred [75]. Cost savings were achieved in that there was reduced need for transfusions, reduced use of blood products, shorter pump times and reduced length of stay.…”

Section: Determining the Most Cost Effective Uses Of Aprotininmentioning

confidence: 99%

Role of aprotinin in the management of patients during and after cardiac surgery

Punjabi¹,

Wyse²,

Taylor³

2000

Expert Opinion on Pharmacotherapy

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Management of patients undergoing cardiac surgery has evolved in recent years as more is understood about the physiological changes and responses that occur during and after cardiopulmonary bypass (CPB). In particular, our understanding of the mechanisms involved in haemostasis and in the inflammatory response to bypass surgery, has allowed significant refinements in patient management. Improvements in the pharmacological conservation of blood loss have been striking, particularly with the development of the serine protease inhibitor, aprotinin (Trasylol, Bayer). Aprotinin represents a significant improvement, especially for patients at high risk, since it reduces the need for allogeneic and (sometimes scarce) blood products. However, in view of its cost, making an appropriate selection of patients most at risk of serious blood loss is a major consideration in the use of aprotinin. While its mechanisms of action are not well understood, the use of aprotinin also appears to reduce inflammatory response to CPB.

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Reduction in Costs, Blood Products, and Operating Time in Patients Undergoing Open Heart Surgery

Abstract: Use of aprotinin at half dose in a community hospital resulted in a significant reduction in costs, blood product use, and operating room closure time in patients undergoing open heart surgery.

Cited by 18 publications

References 9 publications

Transfusion-Related Cost of Adjunct Aprotinin Application in One-Step Infected Hip Revision Arthroplasty – Cost-Minimizing Analysis

Transfusion-Related Cost of Adjunct Aprotinin Application in One-Step Infected Hip Revision Arthroplasty – Cost-Minimizing Analysis

Antifibrinolytic Agents and Desmopressin as Hemostatic Agents in Cardiac Surgery

Role of aprotinin in the management of patients during and after cardiac surgery

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