Shed mediastinal blood transfusion after cardiac operations: a cost-effectiveness analysis.
BACKGROUND
Cardiac surgical patients consume a significant fraction of the annual volume of allogeneic blood transfused. Scavenged autologous blood may serve as a cost-effective means of conserving donated blood and avoiding transfusion-related complications.


METHODS
This study examines 834 patients after cardiac operations at the University of Alabama Hospital. Data were collected on patients receiving unwashed, filtered, autologous transfusions from shed mediastinal drainage and those receiving allogeneic transfusions. The data were incorporated into clinical decision models; confidence intervals for parameters were estimated by bootstrapping sample statistics. Costs were estimated for transfusing both allogeneic and autologous blood.


RESULTS
The study found a 54% reduction in transfusion risk or a mean reduction of 1.41 allogeneic units per case (95% confidence interval, 1.04 to 1.79 units). The process saved between $49 and $62 per case.


CONCLUSIONS
The use of autologous blood has the potential to significantly reduce the costs and risks associated with transfusing allogeneic blood after cardiac operations.
Kilgore
M L
ML
Department of Pathology, University of Alabama at Birmingham 35233-7331, USA. kilgore@wp.path.uab.edu
Pacifico
A D
AD
D000328:Adult; D000407:Alabama / Q000453:epidemiology; D000707:Anaphylaxis / Q000191:economics; D001803:Blood Transfusion / Q000191:economics / Q000706:statistics & numerical data; D001804:Blood Transfusion, Autologous / Q000191:economics* / Q000706:statistics & numerical data; D006348:Cardiac Surgical Procedures / Q000191:economics* / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D004322:Drainage; D005260:Female; D015658:HIV Infections / Q000191:economics; D006509:Hepatitis B / Q000191:economics; D006526:Hepatitis C / Q000191:economics; D006801:Humans; D016018:Least-Squares Analysis; D016015:Logistic Models; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D012307:Risk Factors; D012680:Sensitivity and Specificity; D065227:Transfusion Reaction