title: Ten-year patterns in blood product utilization during cardiothoracic surgery with cardiopulmonary bypass in a tertiary hospital.
abstract: BACKGROUND
  This retrospective analysis describes blood conservation strategies and overall consumption of red blood cells (RBCs), fresh-frozen plasma (FFP), and platelet (PLT) concentrates during nonaortic cardiac surgery with cardiopulmonary bypass (CPB) in a tertiary hospital over a 10-year period.
  
  
  METHODS
  Study variables of 6026 patients that underwent cardiac surgery between 2002 and 2011 were incorporated in the database and included hemoglobin (Hb), lowest temperature, CPB duration, 24-hour blood loss, fluid balance, and overall transfusion requirements.
  
  
  RESULTS
  Between 2002 and 2011, the lowest intraoperative Hb levels and temperature increased from 8.5 ± 1.2 to 10.4 ± 1.4 g/dL and from 32 ± 2 to 34 ± 1°C, respectively. In addition to the steep decrease in the postoperative fluid balance over time, a reduction in 24-hour blood loss from 815 ± 588 mL (2002) to 590 ± 438 mL (2011) was observed. These changes were paralleled by a 28% reduction in overall RBC transfusion from 1443 units in 2002 to 1038 in 2011. While RBC transfusion decreased over time, there was no significant change in the use of FFP or PLT concentrate transfusion. The probability to receive RBC transfusion increased after cessation of aprotinin, but reduced after routine cell salvage in all operations.
  
  
  CONCLUSIONS
  This institutional report shows a large reduction in blood loss and transfusion requirements in cardiac surgery over a 10-year period. This reduction is most probably attributed to structural cell salvage, reduced intraoperative fluid volumes, and the increase in the lowest intraoperative body temperature.
authors.affiliation: Department of Cardio-thoracic Surgery, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Alexander B A
authors.initials: AB
authors.lastname: Vonk
authors.forename: Michael I
authors.initials: MI
authors.lastname: Meesters
authors.forename: Wouter B
authors.initials: WB
authors.lastname: van Dijk
authors.forename: Leon
authors.initials: L
authors.lastname: Eijsman
authors.forename: Johannes W A
authors.initials: JW
authors.lastname: Romijn
authors.forename: Evert K
authors.initials: EK
authors.lastname: Jansen
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Loer
authors.forename: Christa
authors.initials: C
authors.lastname: Boer
mesh_terms: D000465:Algorithms; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001810:Blood Volume; D001831:Body Temperature; D002315:Cardiopulmonary Bypass / Q000706:statistics & numerical data*; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D016208:Databases, Factual / Q000706:statistics & numerical data; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D006454:Hemoglobins; D006801:Humans; D007432:Intraoperative Period; D057725:Operative Blood Salvage; D010949:Plasma; D017713:Platelet Transfusion / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011364:Professional Practice; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*
chemical_list: D006454:Hemoglobins