title: Blood product conservation is associated with improved outcomes and reduced costs after cardiac surgery.
abstract: BACKGROUND
  Efforts to reduce blood product use have the potential to avoid transfusion-related complications and reduce health care costs. The purpose of this investigation was to determine whether a multi-institutional effort to reduce blood product use affects postoperative events after cardiac surgical operations and to determine the influence of perioperative transfusion on risk-adjusted outcomes.
  
  
  METHODS
  A total of 14,259 patients (2006-2010) undergoing nonemergency, primary, isolated coronary artery bypass grafting operations at 17 different statewide cardiac centers were stratified according to transfusion guideline era: pre-guideline (n = 7059, age = 63.7 ± 10.6 years) versus post-guideline (n = 7200, age = 63.7 ± 10.5 years). Primary outcomes of interest were observed differences in postoperative events and mortality risk-adjusted associations as estimated by multiple regression analysis.
  
  
  RESULTS
  Overall intraoperative (24% vs 18%, P < .001) and postoperative (39% vs 33%, P < .001) blood product transfusion were significantly reduced in the post-guideline era. Patients in the post-guideline era demonstrated reduced morbidity with decreased pneumonia (P = .01), prolonged ventilation (P = .05), renal failure (P = .03), new-onset hemodialysis (P = .004), and composite incidence of major complications (P = .001). Operative mortality (1.0% vs 1.8%, P < .001) and postoperative ventilation time (22 vs 26 hours, P < .001) were similarly reduced in the post-guideline era. Of note, after mortality risk adjustment, operations performed in the post-guideline era were associated with a 47% reduction in the odds of death (adjusted odds ratio, 0.57; P < .001), whereas the risk of major complications and mortality were significantly increased after intraoperative (adjusted odds ratio, 1.86 and 1.25; both P < .001) and postoperative (adjusted odds ratio, 4.61 and 4.50, both P < .001) transfusion. Intraoperative and postoperative transfusions were associated with increased adjusted incremental total hospitalization costs ($4408 and $10,479, respectively).
  
  
  CONCLUSIONS
  Implementation of a blood use initiative significantly improves postoperative morbidity, mortality, and resource utilization. Limiting intraoperative and postoperative blood product transfusion decreases adverse postoperative events and reduces health care costs. Blood conservation efforts are bolstered by collaboration and guideline development.
authors: Department of Surgery, University of Virginia, Charlottesville, VA 22908, USA. djl8w@virginia.edu
authors: Damien J
authors: DJ
authors: LaPar
authors: Ivan K
authors: IK
authors: Crosby
authors: Gorav
authors: G
authors: Ailawadi
authors: Niv
authors: N
authors: Ad
authors: Elmer
authors: E
authors: Choi
authors: Bruce D
authors: BD
authors: Spiess
authors: Jeffery B
authors: JB
authors: Rich
authors: Vigneshwar
authors: V
authors: Kasirajan
authors: Edwin
authors: E
authors: Fonner
authors: Irving L
authors: IL
authors: Kron
authors: Alan M
authors: AM
authors: Speir
mesh_terms: D000925:Anticoagulants / Q000191:economics; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000191:economics*; D001026:Coronary Artery Bypass / Q000191:economics* / Q000401:mortality; D003627:Data Interpretation, Statistical; D005260:Female; D019983:Guideline Adherence; D017722:Hospital Charges / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000517:prevention & control*; D020379:Risk Adjustment; D012307:Risk Factors
chemical_list: D000925:Anticoagulants