title: Risk-adjusted clinical outcomes in patients enrolled in a bloodless program.
abstract: BACKGROUND
  Although clinical outcomes have been reported for patients who do not accept allogeneic blood transfusion (ABT), many previous studies lack a control group, fail to use risk adjustment, and focus exclusively on cardiac surgery.
  
  
  METHODS
  We report a risk-adjusted, propensity score-matched, retrospective case-control study of clinical outcomes for inpatients who did not accept ABT (bloodless, n = 294) and those who did accept ABT (control, n = 1157). Multidisciplinary specialized care was rendered to the bloodless patients to conserve blood and optimize clinical outcomes. Differences in hemoglobin (Hb), mortality, five morbid outcomes, and hospital charges and costs were compared. Subgroups of medical and surgical patients were analyzed, and independent predictors of outcome were determined by multivariate analysis.
  
  
  RESULTS
  Overall, mortality was lower in the bloodless group (0.7%) than in the control group (2.7%; p = 0.046), primarily attributed to the surgical subgroup. After risk adjustment, bloodless care was not an independent predictor of the composite adverse outcome (death or any morbid event; p = 0.91; odds ratio, 1.02; 95% confidence interval, 0.68-1.53). Discharge Hb concentrations were similar in the bloodless (10.8 ± 2.7 g/dL) and control (10.9 ± 2.3 g/dL) groups (p = 0.42). Total and direct hospital costs were 12% (p = 0.02) and 18% (p = 0.02) less, respectively, in the bloodless patients, a difference attributed to the surgical subgroup.
  
  
  CONCLUSIONS
  Using appropriate blood conservation measures for patients who do not accept ABT results in similar or better outcomes and is associated with equivalent or lower costs. This specialized care may be beneficial even for those patients who accept ABT.
authors.affiliation: Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Frank
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Wick
authors.forename: Amy E
authors.initials: AE
authors.lastname: Dezern
authors.forename: Paul M
authors.initials: PM
authors.lastname: Ness
authors.forename: Jack O
authors.initials: JO
authors.lastname: Wasey
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Pippa
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Dackiw
authors.forename: Linda M S
authors.initials: LM
authors.lastname: Resar
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000453:epidemiology* / Q000628:therapy; D001803:Blood Transfusion; D057668:Bloodless Medical and Surgical Procedures / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D003953:Diagnosis-Related Groups; D005260:Female; D006454:Hemoglobins; D017721:Hospital Costs / Q000639:trends; D017052:Hospital Mortality; D006801:Humans; D033221:Jehovah's Witnesses; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data*; D010348:Patient Care Team / Q000191:economics / Q000592:standards*; D015995:Prevalence; D012189:Retrospective Studies; D020379:Risk Adjustment; D016312:Treatment Refusal; D055815:Young Adult
chemical_list: D006454:Hemoglobins