Cost Analysis of Transfusion Therapy in Coronary Artery Surgery

Abstract

Background In patients undergoing coronary artery bypass grafting (CABG), wide variability in transfusion rate (7.8% to 92.8%) raises the question of the amount of unnecessary transfusions. The aim of the study was (1) to identify CABG patients at low risk of bleeding to whom transfusion treatment should be avoided and (2) to calculate the amount of possible cost savings that would be achieved by avoiding transfusion in low bleeding risk patients. Methods This retrospective observational study enrolled patients undergoing isolated elective CABG from January 2010 to January 2018. Patients were divided with respect to the presence of excessive bleeding and transfusion costs were compared between the two groups. Predictors for postoperative excessive bleeding were defined and multivariable logistic regression analysis and risk modeling were performed. The use of a model to predict patients at low risk of bleeding allowed for the estimation of transfusion cost savings assuming the patients who were found to be at low risk of bleeding should not be transfused. Results A total of 1,426 patients were enrolled in the analysis. Of those, 28.3% had excessive postoperative bleeding. The multivariate logistic regression analysis model was developed to identify/predict patients without excessive bleeding (receiver operating characteristic curve analysis, area under the curve 72.3%, p < 0.001). When applied to the existing database, the use of the developed model identifying patients at low risk of bleeding may result in a 39.1% reduction of transfusions. Specifically, cost savings would be 48.2% for packed red blood cells, 38.9% for fresh frozen plasma, 10.9% for platelets concentrate, and 17.9% for fibrinogen concentrate. Conclusion The clinical and economic burdens associated with unnecessary transfusions are significant. Avoiding transfusion in CABG patients found to be at low risk of bleeding may result in significant reduction of transfusion rate and transfusion-associated costs.

Bleeding Risk Stratification in Coronary Artery Surgery the Should-Not-Bleed Score

“…We developed SHOULD-NOT-BLEED-SCORE Windows platform application. The application is grounded on the results of our recent study (5).…”

“…The SHOULD-NOT-BLEED-SCORE risk scoring tool is based on our previous research data that have already been published (5). The intention to develop the scoring system based on published data for which we already have approval was expressed to the Institutional Ethics committee.…”

“…Transfusion of blood components in CABG patients is primarily empiric resulting inevitably in wide variability in transfusion rates between different cardiac surgery centers (range 7.8% to 92.8%) (4). This in turn results with signi cant economic burden and unnecessary expenditures be it from transfusion costs or costs related to transfusion associated complications, as well as overhead expenses (5,6) When it comes to the hemostatic management, the focus of many researchers, including our research team was to identify the patients at high risk of bleeding who might bene t from more aggressive and more targeted haemostatic management. In patients considered to be at high risk of bleeding, the aim of hemostatic management is to provide targeted and e cient haemostatic treatment (mostly procoagulant blood components).…”

“…Recently, we changed our paradigm of hemostatic management and shifted our focus towards identi cation of low bleeding risk patients undergoing low risk procedures (ie. CABG) (5). Herein we present our institutional bleeding risk score, based on our own data and own, recently published, peer reviewed results (5).…”

“…CABG) (5). Herein we present our institutional bleeding risk score, based on our own data and own, recently published, peer reviewed results (5). The score was embedded into "Windows" platform application with user friendly interface and was named "SHOULD-NOT-BLEED" score.…”