title: Thromboelastography--does it impact blood component transfusion in pediatric heart surgery?
abstract: BACKGROUND
  The administration of blood products during pediatric cardiac surgery is common. We sought to determine if thromboelastography (TEG) is a cost-effective tool to reduce blood product transfusion in open pediatric cardiac surgery.
  
  
  METHODS
  A retrospective case-control study was undertaken for 150 pediatric cardiac patients requiring cardiopulmonary bypass from January 2010-May 2012, in a University-affiliated pediatric hospital. Fifty sequential patients operated on when TEG was used were compared with 100 control patients before TEG availability. Groups were matched 2:1 for age and risk adjustment for congenital heart surgery score. Blood product utilization was compared between groups, as were outcomes metrics such as postoperative complications, length of stay, and hospital costs of transfusions.
  
  
  RESULTS
  Demographic variables, risk adjustment for congenital heart surgery score classifications, and cardiopulmonary bypass times were similar between groups. Red cell and plasma transfusion were comparable between groups. TEG patients saw a substantial reduction in the administration of platelet (1 versus 2.2 U; P < 0.0001) and cryoprecipitate (0.7 versus 1.7 U; P < 0.0001) transfusions. A greater than 50% reductions in hospital costs of platelet ($595 versus $1309) and cryoprecipitate ($39 versus $94) transfusions were observed in the TEG group. Mortality, length of stay, ventilator requirements, postoperative bleeding, and thrombotic events were equivalent.
  
  
  CONCLUSIONS
  Intraoperative TEG use reduced platelet and cryoprecipitate transfusions without an increase in postoperative complications. TEG is a cost-effective method to direct blood product replacement.
authors.affiliation: Department of Cardiothoracic Surgery, University of Texas Health Sciences Center San Antonio, San Antonio, Texas. Electronic address: lauren.kane@bcm.edu.
authors.forename: Lauren C
authors.initials: LC
authors.lastname: Kane
authors.affiliation: Department of Pediatrics, University of Texas Health Sciences Center San Antonio, San Antonio, Texas.
authors.forename: Cathy S
authors.initials: CS
authors.lastname: Woodward
authors.affiliation: Department of Cardiothoracic Surgery, University of Texas Health Sciences Center San Antonio, San Antonio, Texas.
authors.forename: Syed Adil
authors.initials: SA
authors.lastname: Husain
authors.affiliation: Department of Pediatrics, University of Texas Health Sciences Center San Antonio, San Antonio, Texas.
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Frei-Jones
mesh_terms: D000293:Adolescent; D016913:Blood Component Transfusion / Q000191:economics / Q000706:statistics & numerical data*; D006348:Cardiac Surgical Procedures / Q000191:economics*; D002315:Cardiopulmonary Bypass; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007430:Intraoperative Care / Q000191:economics / Q000379:methods*; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology / Q000209:etiology; D015995:Prevalence; D012189:Retrospective Studies; D013781:Texas; D013916:Thrombelastography / Q000191:economics*; D055815:Young Adult
keywords: Bleeding; Bleeding control; Cardiopulmonary bypass; Coagulopathy; Congenital heart disease; Thromboelastography; Thrombosis