title: Retrospective analysis of community hospital red blood cell recovery procedures: improved utilization needed for effectiveness.
abstract: BACKGROUND
  Perioperative blood recovery (PBR) is an important component of patient blood management. We analyzed our experience providing PBR for community hospitals to determine procedure types and clinical variables associated with efficacy and cost-effectiveness.
  
  
  METHODS
  PBR cases (>25,000) from January 2008 through December 2012 were analyzed. For each procedure type, the median number of returned red blood cell units (rRBCs) and ratio of cases with at least 1 to less than 1 rRBC unit were calculated. Clinical predictors of rRBC were identified by linear and logistic regression.
  
  
  RESULTS
  The overall median rRBC was 0.29 units despite median estimated blood loss (EBL) of 350 mL. Only three of 31 common procedure types had ≥1:<1 rRBC ratios near to or higher than 1. In nine of 31 common procedure types, at least 50% of cases had no rRBC return. Linear regression demonstrated significant association of rRBCs with increased EBL, longer operative duration, surgeon, PBR device type (autoLog vs. CS5), and decreasing age. EBL, autoLog use, high surgeon case volume, vascular procedures, and emergent versus elective procedures associated with higher odds of at least 1 rRBC.
  
  
  CONCLUSIONS
  Discrepancy between rRBC and EBL and high percentages of cases with no rRBC suggests that PBR technique and case selection need optimization. Identification of procedure types and variables associated with PBR efficacy (≥1 rRBC) should improve utilization of PBR. Association of autoLog use with higher rRBC warrants further investigation.
authors.affiliation: Clinical Services, New York Blood Center, New York, New York.
authors.forename: Michael
authors.initials: M
authors.lastname: Bellone
authors.affiliation: Clinical Services, New York Blood Center, New York, New York.|Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Huy P
authors.initials: HP
authors.lastname: Pham
authors.affiliation: Clinical Services, New York Blood Center, New York, New York.
authors.forename: Beth H
authors.initials: BH
authors.lastname: Shaz
authors.affiliation: Clinical Services, New York Blood Center, New York, New York.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Shi
mesh_terms: D016063:Blood Loss, Surgical; D003362:Cost-Benefit Analysis; D017558:Elective Surgical Procedures; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D006742:Hospital Bed Capacity; D006764:Hospitals, Community / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D009519:New York City; D057725:Operative Blood Salvage / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013043:Specialties, Surgical; D013514:Surgical Procedures, Operative