Determination of Unnecessary Blood Transfusion by Comprehensive 15-Hospital Record Review

Jadwin, David F.; Fenderson, Patricia G.; Friedman, Mark T.; Jenkins, Ian; Shander, Aryeh; Waters, Jonathan H.; Friedman, Arnold J.; Tesoriero, Eric; Refaai, Majed A.; Shih, Andrew W.; Awan, Tauhid; Ngo, Andy L.; Perez, Abe; Reynolds, James D.

doi:10.1016/j.jcjq.2022.10.006

Cited by 2 publications

(2 citation statements)

References 23 publications

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“…Unnecessary blood transfusions are of major concern, not only because of the negative impact on the health status of patients but also on the spending of healthcare budgets [ 24 , 29 , 30 ]. In a recent literature review of observational retrospective studies [ 31 ] covering the blood transfusion practices during 2012–2018, it was found that only 8.2% of patients did not receive unnecessary units and 45.4% of RBC transfusions were unnecessary, and similar results were observed in Turkey. A study by Unal et al [ 32 ] concluded that RBC transfusion in Turkey was inappropriate in 99% (150/151) of patients preoperatively, in 23% (211/926) of patients intraoperatively, and in 43% (308/716) of patients postoperatively.…”

Section: Introductionmentioning

confidence: 62%

Cost-Effectiveness and Budget Impact Analyses of Patient Blood Management in a Cardiovascular Surgery Department at Ankara Bilkent City Hospital in Turkey

Şanal,

Günaydın,

Tatar

2023

Adv Ther

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Introduction Anemia and transfusion of blood products are risk factors associated with poor patient outcomes across all elective surgeries. Patient blood management (PBM) is a patient-centered approach to optimize patient’s endogenous red cell mass, to minimize blood loss in patients undergoing surgery, and to harness and optimize patient-specific physiological tolerance to anemia. This study aimed to assess (1) the impact of PBM on blood product usage in cardiovascular surgeries in a state hospital setting, (2) cost-effectiveness of PBM with a model based on transfusion of red blood cells (RBCs) in cardiovascular surgeries, and (3) the budget impact of PBM implementation based on transfusion of RBCs. Methods Cost-effectiveness and budget impact models, based on the numbers of avoided transfusions and avoided complications after implementation of the PBM program, were compared between pre- and post-PBM periods at the cardiovascular surgery department of Ankara Bilkent City Hospital between February 11, 2019 and July 24, 2022. The probabilities of transfusions and complications with and without PBM were taken from recent meta-analyses. Data from the Ankara Bilkent City Hospital transfusion center informed the pre- and post-PBM calculations. Costs were calculated from the Social Security Institution’s perspective. Results There was a 21% decrease in the use of RBCs and a 23.7% decrease in use of all blood products after the implementation of PBM. The number of RBC packs per patient reduced by 0.88 packs (21%). The cost saving from reduction of RBC transfusions per patient was 518.68 Turkish lira (TRY) and for the hospital it was 1,635,948 TRY. Fewer complications and lower costs in favor of the post-PBM arm were demonstrated in the cost-effectiveness analysis. On the basis of the budget impact model, in 20 months, the hospital’s cardiovascular surgery department saved 6,596,934 TRY (€342,302). Conclusion This hospital-based study demonstrated that PBM is a budget-saving and cost-effective option in Turkey. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-023-02733-5.

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Section: Introductionmentioning

confidence: 62%

Cost-Effectiveness and Budget Impact Analyses of Patient Blood Management in a Cardiovascular Surgery Department at Ankara Bilkent City Hospital in Turkey

Şanal,

Günaydın,

Tatar

2023

Adv Ther

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“…Surgical transplant pioneers have applied transfusion-avoidance strategies and larger series have demonstrated surgical feasibility when layered atop preexisting transfusion-free platforms. Blood conservation practices have become recognized as a new wave in national quality and performance improvement [41,42,43 ▪▪ ].…”

Section: Discussionmentioning

confidence: 99%

Ethical issues in solid organ transplantation: transfusion-free transplantation in Jehovah's witness patients

Selby,

Selby-Medical,

Richman

2023

Current Opinion in Organ Transplantation

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Purpose of review Jehovah's Witnesses do not accept transfusion of major allogeneic blood fractions. Successful solid organ transplantation is challenging for Jehovah's Witnesses when anemia, coagulation disturbances, and difficult technical aspects co-exist, and key blood bank resources cannot be utilized. Organ availability for transplantation is limited and demand exceeds supply for all organ types. Historically, the likelihood of poor outcomes in Jehovah's Witnesses patients placed ethical limitations on transplant candidacy for this population violating the precept of maximal utilization of a limited resource. The review's purpose is to describe advancements and strategies that make Jehovah's Witnesses transplant outcomes comparable to transfusion-eligible patients and allay the ethical concerns of their candidacy. Recent findings Immunomodulation from allogeneic transfusion is a cause of significant postop morbidity. Blood conservation strategies have led to improved outcomes across different medical and surgical cohorts and set the stage for expanded utility in Jehovah's Witnesses with organ insufficiency. Published single-center series with descriptions of specific peri-operative strategies describe the path to major blood product avoidance. Summary Comparable outcomes in solid organ transplantation for Jehovah's Witnesses without allogeneic transfusion are possible when inclusion-exclusion criteria are respected, and blood conservation strategies employed.

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Determination of Unnecessary Blood Transfusion by Comprehensive 15-Hospital Record Review

Cited by 2 publications

References 23 publications

Cost-Effectiveness and Budget Impact Analyses of Patient Blood Management in a Cardiovascular Surgery Department at Ankara Bilkent City Hospital in Turkey

Cost-Effectiveness and Budget Impact Analyses of Patient Blood Management in a Cardiovascular Surgery Department at Ankara Bilkent City Hospital in Turkey

Ethical issues in solid organ transplantation: transfusion-free transplantation in Jehovah's witness patients

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