title: Cost reduction of perioperative coagulation management in cardiac surgery: value of "bedside" thrombelastography (ROTEM).
abstract: OBJECTIVE
  Demographic changes and aggressive platelet inhibition have resulted in a marked increase in blood- and coagulation product expenditure and costs in cardiac surgery. We analyzed "bedside" coagulation test (ROTEM) in order to verify clot forming quality for the purpose of finding a cost-effective treatment path.
  
  
  METHODS
  Annual treatment costs of all cardiosurgical patients were analyzed before (729 patients) and after (693 patients) implementation of "bedside" ROTEM. Cumulative numbers and costs of platelet concentrates (PltC), fresh frozen plasma (FFP), red blood cell units (RBC), and coagulation factors: pooled coagulation concentrates (PCC), recombinant factor VIIa (rFVIIa), factor XIII (FXIII), and fibrinogen were assessed. Average monthly numbers and costs were compared. Number of resternotomies and early mortality was assessed and compared in both periods.
  
  
  RESULTS
  After ROTEM implementation cumulative RBC expenditure showed 25% decrease while PltC exhibited 50% decrease. FFP expenditure remained unchanged. PCC, FXIII were markedly reduced (-80%) while rFVIIa were entirely omitted. Fibrinogen, however, increased two-fold. Cumulative average monthly costs of all blood products decreased from 66,000 euro to 45,000 euro (-32%). Coagulation factor average monthly costs decreased from 60,000 euro to 30,000 euro (-50%) yielding combined savings of 44%. In contrast, average monthly costs for ROTEM were 1.580 euro. Total number of resternotomies decreased from 6.6% to 5.5% while early mortality (5.9%; 6.0%) remained stable.
  
  
  CONCLUSIONS
  Cumulative costs for treatment of perioperative coagulation disorders can be reduced by "bedside" ROTEM analysis to achieve a selective substitution management. Saved costs for blood- and coagulation products clearly outweighed the expenses of ROTEM. Adequate differential coagulation management can therefore be cost-effective.
authors.affiliation: Department of Cardiovascular Surgery, Heart Center Brandenburg, Ladeburger Strasse 17, 16321 Bernau bei Berlin, Germany.
authors.forename: Grit J
authors.initials: GJ
authors.lastname: Spalding
authors.forename: Martin
authors.initials: M
authors.lastname: Hartrumpf
authors.forename: Tobias
authors.initials: T
authors.lastname: Sierig
authors.forename: Nils
authors.initials: N
authors.lastname: Oesberg
authors.forename: Christian Günther
authors.initials: CG
authors.lastname: Kirschke
authors.forename: Johannes M
authors.initials: JM
authors.lastname: Albes
mesh_terms: D000368:Aged; D000990:Antithrombin III / Q000191:economics; D007611:Aprotinin / Q000191:economics; D001778:Blood Coagulation Disorders / Q000191:economics / Q000517:prevention & control*; D001779:Blood Coagulation Factors / Q000191:economics; D001780:Blood Coagulation Tests; D001792:Blood Platelets; D006348:Cardiac Surgical Procedures / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D003894:Deamino Arginine Vasopressin / Q000191:economics; D004912:Erythrocytes; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D010949:Plasma; D013916:Thrombelastography / Q000191:economics* / Q000379:methods
chemical_list: D001779:Blood Coagulation Factors; D000990:Antithrombin III; D007611:Aprotinin; D003894:Deamino Arginine Vasopressin