title: Economic aspects of intraoperative coagulation management targeting higher fibrinogen concentrations during major craniosynostosis surgery.
abstract: BACKGROUND
  Results of a previously published study demonstrated a significant decrease in transfusion requirements and calculated blood loss for pediatric major craniosynostosis surgery, if a ROTEM(®) FIBTEM trigger of <13 mm (early substitution group) was applied as compared to a trigger of <8 mm (conventional group). The aim of this study was a posthoc analysis of the costs for this coagulation management.
  
  
  METHODS
  The total volume as well as the number of units or bags for all transfused blood products and coagulation factors were recorded for each case. The number of laboratory and point-of-care coagulation tests was also analyzed. Total blood product costs were calculated according to the local prices per unit.
  
  
  RESULTS
  The total cost for all transfused/administered blood products/coagulation factors per patient was a median of 1023EUR (IQR 850EUR-1058EUR) in the early substitution group as compared to a median of 910EUR (IQR 719EUR-1351EUR) in the conventional group (P = 0.81). No difference in the number of coagulation tests performed was observed.
  
  
  CONCLUSIONS
  In this study, the use of a higher fibrinogen trigger was not linked to a significant increase in total costs for transfused blood products and coagulation factors, and may offer an economically equivalent approach to coagulation management.
authors.affiliation: Department of Anesthesia, Zurich University Children's Hospital, Zurich, Switzerland.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Haas
authors.affiliation: Department of Anesthesia, Zurich University Children's Hospital, Zurich, Switzerland.
authors.forename: Nelly
authors.initials: N
authors.lastname: Spielmann
authors.affiliation: Department of Anesthesia, Zurich University Hospital, Zurich, Switzerland.
authors.forename: Tanja
authors.initials: T
authors.lastname: Restin
authors.affiliation: Department of Anesthesia, Zurich University Children's Hospital, Zurich, Switzerland.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Schmidt
authors.affiliation: Department of Hematology, Zurich University Children's Hospital, Zurich, Switzerland.
authors.forename: Markus
authors.initials: M
authors.lastname: Schmugge
authors.affiliation: Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Cushing
mesh_terms: D000293:Adolescent; D001777:Blood Coagulation / Q000502:physiology; D001779:Blood Coagulation Factors / Q000008:administration & dosage / Q000191:economics*; D001803:Blood Transfusion / Q000191:economics* / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis / Q000706:statistics & numerical data*; D003398:Craniosynostoses; D005260:Female; D005340:Fibrinogen / Q000032:analysis / Q000191:economics*; D006490:Hemostatics; D006801:Humans; D007223:Infant; D007430:Intraoperative Care / Q000191:economics* / Q000379:methods; D008297:Male; D011446:Prospective Studies
chemical_list: D001779:Blood Coagulation Factors; D006490:Hemostatics; D005340:Fibrinogen
keywords: blood transfusion; cost analysis; fibrinogen; hemorrhage; pediatrics; thromboelastometry