Cost-effectiveness of blood transfusion and white cell reduction in elective colorectal surgery.
BACKGROUND
The use of white cell (WBC)-reduced blood in elective colorectal surgery appears to reduce the frequency of postoperative infection. The question to be addressed is whether the cost:benefit ratio justifies the recommendation that WBC-reduced blood should be used for all colorectal surgery.


METHODS
Patients admitted for elective colorectal surgery (n = 197) were randomly assigned to receive transfusion consisting of whole blood or WBC-reduced whole blood. Postoperative complications, postoperative stay, and hospital charges were compared.


RESULTS
Forty-eight patients received WBC-reduced whole blood, 56 received unfiltered whole blood, and 93 received no transfusion. Postoperative infections were significantly higher (p < 0.001) in the group that received unfiltered whole blood. That group also had longer hospital stays: 17 days as compared to stays of 10 and 11 days for the group receiving no transfusion and the group receiving filtered whole blood transfusions, respectively (p < 0.01). The total hospital cost per patient receiving unfiltered whole blood was $12,347, as compared to $7,867 for those who received WBC-reduced whole blood and $7,030 for those who received no transfusion.


CONCLUSIONS
The use of WBC-reduced whole blood transfusions in elective colorectal surgery significantly reduces the frequency of postoperative infection, the length of hospital stay, and the total hospital charges for patients needing blood transfusion.
Jensen
L S
LS
Department of Surgical Gastroenterology, Aarhus University Hospital, Denmark.
Grunnet
N
N
Hanberg-Sørensen
F
F
Jørgensen
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000191:economics* / Q000379:methods; D003108:Colonic Diseases / Q000191:economics / Q000601:surgery*; D003365:Costs and Cost Analysis; D017707:Erythrocyte Transfusion / Q000191:economics*; D005260:Female; D006801:Humans; D017053:Infection Control; D007937:Leukapheresis / Q000191:economics; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D012002:Rectal Diseases / Q000191:economics / Q000601:surgery*