A case-control study of the impact of WBC reduction on the cost of hospital care for patients undergoing coronary artery bypass graft surgery.
BACKGROUND
WBC reduction of blood components may reduce the incidence of transfusion reactions. The cost of this intervention might be offset by a reduction in the incidence of postoperative infection, thereby reducing the length of hospital stay and thus the cost of care for patients receiving transfusion. Cedars-Sinai Medical Center provided WBC-reduced blood components to all patients for a period of 2 years, creating an opportunity to compare the incidence of postoperative infection, length of hospital stay, and total hospital costs for patients undergoing coronary artery bypass graft surgery, before, during, and after WBC reduction.


METHODS
Data were obtained by examining hospital records of patients who received transfusion and control patients who did not receive transfusion for the years 1991 (before WBC reduction), 1992 to 1993 (during WBC reduction), and 1994 (following discontinuation of WBC reduction). Comparisons were made by use of ANOVA following log or square root transformation of the data.


RESULTS
Length of hospital stay for patients who received transfusion decreased over time. Mean hospital stays were 15.9, 14.1, and 12.1 days before, during, and after WBC reduction, respectively. A similar trend was seen in the patients who did not receive transfusion. There was no indication that WBC reduction functioned as an independent variable that was responsible for the observed decrease. The rate of postoperative infection stayed constant during WBC reduction and only dropped when WBC reduction was stopped. Mean hospital cost showed no significant change over time for either the transfusion group or the nontransfusion group.


CONCLUSIONS
The cost of providing a totally WBC-reduced blood supply may not be offset by immediate savings related to decreased postoperative infections, reduced length of hospital stay, and cost of hospital care.
Volkova
Natalia
N
Division of Transfusion Medicine, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
Klapper
Ellen
E
Pepkowitz
Samuel H
SH
Denton
Timothy
T
Gillaspie
Glenn
G
Goldfinger
Dennis
D
D000368:Aged; D000369:Aged, 80 and over; D016913:Blood Component Transfusion / Q000009:adverse effects / Q000191:economics*; D001803:Blood Transfusion / Q000191:economics; D016022:Case-Control Studies; D001026:Coronary Artery Bypass / Q000191:economics*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007165:Immunosuppression Therapy; D007239:Infections / Q000453:epidemiology; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D007962:Leukocytes; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D065227:Transfusion Reaction