Transfusion therapy in cardiac surgery: impact of the Paul Gann Blood Safety Act in California.
The Paul Gann Blood Safety Act became law in California on January 1, 1990, mandating that patients be informed of the risks and alternatives of blood transfusions. To evaluate the impact of this legislation, the authors compared transfusion therapy in patients undergoing cardiac surgery during 1990 to previous years (1986 to 1987 and 1989). Surgical techniques were unchanged. Homologous component usage was 8.7 +/- 0.6 (mean +/- SE) units/patient in 1986 to 1987 (n = 373), 8.2 +/- 0.9 in 1989 (n = 219) and 4.3 +/- 0.6 in 1990 (n = 222), P less than .001 by ANOVA. Erythrocyte transfusions were 3.5 +/- 0.2, 3.2 +/- 0.2, and 2.2 +/- 0.2 units/patient (P less than .001); platelet/plasma usage was 5.2 +/- 0.5, 4.9 +/- 0.7 and 2.1 +/- 0.4 units/patient (P less than .001). The number of patients not requiring transfusions increased from 28 per cent in 1989 (61 of 219) to 47 per cent in 1990 (104 of 222). A slight but significant decrease in cardiopulmonary bypass time and perioperative blood loss occurred. The authors conclude that this legislation stimulated the surgical team to control blood loss during surgery and to avoid the anticipatory use of component transfusions.
Carey
J S
JS
Torrance Memorial Medical Center, Department of Surgery, California.
Cukingnan
R A
RA
Carson
E
E
D000368:Aged; D001782:Blood Donors; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D001804:Blood Transfusion, Autologous; D002140:California / Q000453:epidemiology; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D005260:Female; D006324:Heart Arrest, Induced; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007883:Legislation, Medical; D008297:Male; D008875:Middle Aged; D010106:Oxygenators; D010818:Practice Patterns, Physicians'; D012086:Reoperation; D013997:Time Factors
D006454:Hemoglobins