title: Patient blood management in cardiac surgery results in fewer transfusions and better outcome.
abstract: BACKGROUND
  The aim of this study was to investigate the impact of the introduction of a patient blood management (PBM) program in cardiac surgery on transfusion incidence and outcome.
  
  
  METHODS
  Clinical and transfusion data were compared between the pre-PBM epoch (July 2006-March 2007) and the PBM epoch (April 2007-September 2012).
  
  
  RESULTS
  There were a total of 2662 patients analyzed, 387 in the pre-PBM and 2275 in the PBM epoch. Red blood cell (RBC) loss decreased from a mean (±SD) of 810 ± 426 mL (median, 721 mL) to 605 ± 369 mL (median, 552 mL; p < 0.001) and pretransfusion hemoglobin decreased from 7.2 ± 1.4 to 6.6 ± 1.2 g/dL (p < 0.001) in the pre-PBM versus the PBM epoch. In conjunction, this resulted in a reduction of the RBC transfusion rate from 39.3% to 20.8% (p < 0.001). Similar reductions were observed for the transfusion of fresh-frozen plasma (FFP; from 18.3% to 6.5%, p < 0.001) and platelets (PLTs; from 17.8% to 9.8%, p < 0.001). Hospital mortality and cerebral vascular accident incidence remained unchanged in the PBM epoch. However, the incidence of postoperative kidney injury decreased in the PMB epoch (from 7.6% to 5.0%, p = 0.039), length of hospital stay decreased from 12.2 ± 9.6 days (median, 10 days) to 10.4 ± 8.0 days (median, 8 days; p < 0.001), and total adjusted direct costs were reduced from $48,375 ± $28,053 (median, $39,709) to $44,300 ± $25,915 (median, $36,906; p < 0.001).
  
  
  CONCLUSIONS
  Implementing meticulous surgical technique, a goal-directed coagulation algorithm, and a more restrictive transfusion threshold in combination resulted in a substantial decrease in RBC, FFP, and PLT transfusions; less kidney injury; a shorter length of hospital stay; and lower total direct costs.
authors.affiliation: Patient Blood Management Program, Eastern Maine Medical Center, Bangor, Maine.|Department of Hematology and Oncology, Eastern Maine Medical Center, Bangor, Maine.
authors.forename: Irwin
authors.initials: I
authors.lastname: Gross
authors.affiliation: Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.affiliation: Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
authors.forename: Axel
authors.initials: A
authors.lastname: Hofmann
authors.affiliation: Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
authors.forename: Donat R
authors.initials: DR
authors.lastname: Spahn
mesh_terms: D000368:Aged; D000465:Algorithms; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures / Q000379:methods*; D017707:Erythrocyte Transfusion; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion