Blood transfusion reduction in cardiac surgery: multidisciplinary approach at a community hospital.
BACKGROUND
Mounting evidence exists for more restrictive blood transfusion practices in patients undergoing cardiac surgery. Few studies, however, have recognized or agree upon a method by which this decrease in allogeneic red blood cell transfusion can be achieved. We will review our methods and experience in a blood conservation initiative from 2003 to 2007.


METHODS
A data driven, multidisciplinary effort to decrease allogeneic red blood cell transfusion was instituted in a community hospital. Numerous innovations in treatment protocols were implemented and evaluated. Clinical data from 2003 to 2007 will be presented. Yearly review of outcomes led to an evolving clinical practice and lowered transfusion rates.


RESULTS
A total of 2,531 consecutive cardiac surgical procedures were performed during a five-year period. Using a multidisciplinary approach to quality improvement, and with the goal of using fewer blood products, our incidence of allogeneic red blood cell transfusion was decreased, from 43% in 2003 to 18% in 2007. Patient outcomes were not significantly changed.


CONCLUSIONS
Cardiac surgery in a community hospital can be performed safely with low utilization of allogeneic red blood cell transfusions. A multidisciplinary approach to blood conservation can result in lower transfusion rates and equivalent patient outcomes.
Brevig
James
J
Providence Regional Medical Center Everett, Everett, Washington, USA. james.brevig@providence.org
McDonald
Julie
J
Zelinka
Edy S
ES
Gallagher
Trudi
T
Jin
Ruyun
R
Grunkemeier
Gary L
GL
D000368:Aged; D001804:Blood Transfusion, Autologous / Q000009:adverse effects / Q000706:statistics & numerical data*; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data*; D015331:Cohort Studies; D016001:Confidence Intervals; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D017052:Hospital Mortality / Q000639:trends*; D006764:Hospitals, Community; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D019990:Perioperative Care; D011183:Postoperative Complications / Q000401:mortality; D011336:Probability; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D017751:Safety Management; D016019:Survival Analysis