James Brevig, MD, Julie McDonald, BSN, Edy S

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Presentation transcript:

Blood Transfusion Reduction in Cardiac Surgery: Multidisciplinary Approach at a Community Hospital James Brevig, MD, Julie McDonald, BSN, Edy S. Zelinka, CCP, Trudi Gallagher, RN, Ruyun Jin, MD, Gary L. Grunkemeier, PhD The Annals of Thoracic Surgery Volume 87, Issue 2, Pages 532-539 (February 2009) DOI: 10.1016/j.athoracsur.2008.10.044 Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Trend of units transfused per red blood cell (RBC) recipient by year. The Annals of Thoracic Surgery 2009 87, 532-539DOI: (10.1016/j.athoracsur.2008.10.044) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Incidence of RBC transfusion over time by location of administration (intraoperatively vs postoperatively), and by type of procedure (isolated CABG vs CABG/valve and non-CABG). (Grey bars represent the overall incidence of RBC transfusion; RBC = red blood cell; CABG = coronary artery bypass grafting.) The Annals of Thoracic Surgery 2009 87, 532-539DOI: (10.1016/j.athoracsur.2008.10.044) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Intraoperative procedural strategies used to manage red cell mass. (Grey bars represent the overall incidence of RBC transfusion.) The Annals of Thoracic Surgery 2009 87, 532-539DOI: (10.1016/j.athoracsur.2008.10.044) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Cumulative number of patients transfused and the cumulative number of red blood cell (RBC) units used from 2003 to 2007. The trend line is extrapolated from the 2003 and 2004 experience. The grey lines represent the cumulative number of patients transfused. The black lines represent the cumulative units of RBC transfused. The straight lines are the linear fit for the first 2 years data, 2003 and 2004. The divergence of the slope from the trend line shows that blood utilization decreased starting in 2005. Two hundred ninety patients were not transfused and 1,127 RBC units were saved as a result of our blood conservation program from 2005 through 2007. The Annals of Thoracic Surgery 2009 87, 532-539DOI: (10.1016/j.athoracsur.2008.10.044) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Predicted versus observed transfusion rate by two time periods. The predicted risk of transfusion was calculated by Alghamdi and colleagues' Transfusion Risk Understanding Scoring Tool [16]. Patients were grouped by the predicted risk of transfusion. The areas of the circles are proportional to the number of patients in each group: the circles in the legend depict 100 patients. If the real transfusion rate is the same as predicted, the circle would be on the diagonal line of identity. The vertical distance from the diagonal line to the center of a circle represents patients in that group who avoided a predicted red blood cell transfusion. (black circles = 2003 to 2004 [n = 1,043]; grey circles = 2005 to 2007 [n = 1,488].) The Annals of Thoracic Surgery 2009 87, 532-539DOI: (10.1016/j.athoracsur.2008.10.044) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Isolated CABG blood utilization trends in study hospital, PRMCE, with STS and COAP benchmarks, 2003 to 2007. The upper panel shows the transfusion rates of all blood products intraoperatively or postoperatively the lower panel shows the transfusion rates of RBC perioperatively. (PRMCE = Providence Regional Medical Center Everett; STS = Society of Thoracic Surgeon; COAP = Washington State Clinical Outcomes and Assessment Program; RBC = red blood cell.) The Annals of Thoracic Surgery 2009 87, 532-539DOI: (10.1016/j.athoracsur.2008.10.044) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 The cumulative sum (CUSUM) graph of operative mortality by status of red blood cell (RBC) transfusion. The jagged CUSUM line is the cumulative sum of the observed minus expected deaths. The horizontal line represents performance as expected, above the line worse than expected (excess deaths), and below the line better than expected (lives saved). The smooth lines are the 95% prediction limits. Vertical lines indicate 100 surgeries. The odds ratio (OR) and 95% confidence interval (CI) are included. The Annals of Thoracic Surgery 2009 87, 532-539DOI: (10.1016/j.athoracsur.2008.10.044) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions