title: Changes in transfusion therapy and reexploration rate after institution of a blood management program in cardiac surgical patients.
abstract: A retrospective study was performed to determine the impact of a coagulation and transfusion management program on blood utilization in 1,079 sequential patients for myocardial revascularization and open ventricle or combined procedures. Four hundred and eighty-eight patients (group 1) before, and 591 patients (group 2) after institution of thromboelastography (TEG)-guided coagulation were studied and compared for transfusion requirements, donor exposure, and the incidence of reoperation for hemorrhage. Group 2 patients had a significantly lower incidence of overall transfusion (78.5% v 86.3%) during hospitalization and in total transfusion in the operating room (57.9% v 66.4%). The incidence of each transfusion subtype was also significantly lower in group 2 patients. Actual total median donor exposure was 8 in group 1 patients and 6 exposures in group 2 patients. Mediastinal reexploration for hemorrhage was 5.7% before institution of TEG-based coagulation monitoring and 1.5% in TEG-monitored patients. Use of TEG monitoring before reexploration has decreased the cost and potential risk for patients undergoing CABG surgery.
authors.affiliation: Department of Anesthesiology, University of Washington, Seattle 98195, USA.
authors.forename: B D
authors.initials: BD
authors.lastname: Spiess
authors.forename: B S
authors.initials: BS
authors.lastname: Gillies
authors.forename: W
authors.initials: W
authors.lastname: Chandler
authors.forename: E
authors.initials: E
authors.lastname: Verrier
mesh_terms: D001777:Blood Coagulation; D001782:Blood Donors; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D008477:Mediastinal Diseases / Q000453:epidemiology / Q000601:surgery; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D012086:Reoperation / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013916:Thrombelastography; D014861:Washington / Q000453:epidemiology