title: Impact of a blood conservation program on 30-day morbidity and mortality: a cohort study.
abstract: BACKGROUND
  There are little published data on outcomes of blood conservation (BC) patients after noncardiac surgery. The objective of this study was to compare the surgical outcomes of patients enrolled in our BC program with that of the general population of surgical patients.
  
  
  METHODS
  BC patients at our institution undergoing various surgical procedures were identified from the 2007-2009 National Surgical Quality Improvement Program database and compared with a cohort of conventional care (CC) patients matched by age, gender, and surgical procedure. Univariate and multiple logistic regression analyses were performed to evaluate 30-d postoperative outcomes.
  
  
  RESULTS
  One hundred twenty BC patients were compared with 238 CC patients. The two groups were similar for all preoperative variables except smoking, which was lower in the BC group. On univariate analysis, BC patients had similar mean operating time (148 versus 155 min; P = 0.5), length of stay (5.9 versus 5.5 d; P = 0.7), and rate of return to the operating room (7.5% versus 5.5%; P = 0.4) compared with CC patients. BC and CC patients had similar 30-d morbidity (18% versus 14%; P = 0.3) and mortality rates (1.6% versus 1.3%; P = 1.0), respectively. On multivariable analysis, enrollment in the BC program had no impact on postoperative 30-d morbidity (odds ratio, 1.78; 95% confidence interval, 0.71-4.47) or 30-d mortality (unadjusted odds ratio, 1.33; 95% confidence interval, 0.22-8.05).
  
  
  CONCLUSIONS
  Short-term postoperative outcomes in BC patients are similar to the general population, and these patients should not be denied surgical treatment based on their unwillingness to receive blood products.
authors.affiliation: Department of Surgery, Creighton University, Omaha, Nebraska.
authors.forename: Bala
authors.initials: B
authors.lastname: Ramanan
authors.affiliation: Department of Cardiology, Creighton University, Omaha, Nebraska.
authors.forename: Tammy L
authors.initials: TL
authors.lastname: Burns
authors.affiliation: Department of Surgery, Creighton University, Omaha, Nebraska.
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Sugimoto
authors.affiliation: Department of Surgery, Creighton University, Omaha, Nebraska. Electronic address: rarmourforse@creighton.edu.
authors.forename: Robert Armour
authors.initials: RA
authors.lastname: Forse
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000401:mortality* / Q000517:prevention & control*; D057668:Bloodless Medical and Surgical Procedures / Q000379:methods* / Q000401:mortality*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000401:mortality* / Q000517:prevention & control*; D058996:Quality Improvement; D012307:Risk Factors; D016896:Treatment Outcome; D016312:Treatment Refusal
keywords: Blood conservation; NSQIP; Surgical outcomes