Outcomes after multidisciplinary blood management in adult patients undergoing cardiac surgery: a retrospective observational study

Abstract

BackgroundMore than 250 000 patients undergo cardiac surgery in China annually, and 70% of them receive blood transfusion perioperatively. These two figures put together is a great burden on blood supply in China, and the gap between the supply and consumption of blood products is becoming more and more prominent. Accumulating evidence shows that blood transfusion is associated with increased postoperative morbidity and mortality in patients undergoing cardiac surgery. The aim of this study was to investigate a single institution's experience with implementing multidisciplinary patient blood management (PBM) strategy in adult patients undergoing cardiac surgery. MethodsA multidisciplinary PBM strategy was instituted in Fuwai Hospital in January 2009. The strategy included the establishment of a multidisciplinary blood transfusion management team and the designation of a coordinator, enactment perioperative transfusion triggers (haemoglobin concentration <80 g/L) for adults patients undergoing cardiac surgery, the common use of antifibrinolytics and cell salvage, a reduction of cardiopulmonary bypass circuit, and the creation of the Blood Consumption Announcement and Scoring System, which regularly publishes notifications of blood volume consumed per case, per single procedure, and per surgeon. For indicators of outcome of the PBM strategy, we analysed the incidence of red-blood-cell transfusion before and after PBM, postoperative hospital length of stay, and in-hospital mortality. This retrospective study and the patient consent was approved by the ethics committee of Fuwai hospital. Findings50453 consecutive adult patients underwent coronary artery bypass grafting, valvular heart surgery, Aortic surgery, other adult cardiac or combined surgery were analyzed. 5574 cases were performed in the year of 2008, and 6336, 6663, 7075, 7620, 8387 and 8798 cases were performed from 2009 to 2014 respectively. The incidence of allogeneic red blood cell transfusion perioperatively were decreased significantly since 2009 (from 2008 to 2014: 75·3%, 58·3%, 47·5%, 33·1%, 27·5%, 27·1%, and 26·6%, p<0.0001). The postoperative hospital length of stay were reduced (from 2008 to 2014: 10·5 days, 10·1 days, 9·6 days, 9·0 days, 8·2 days, 8·0 days, and 7·5 days, p=0·02). In-hospital mortality decreased year by year (from 2008 to 2014: 1·2%, 0·9%, 0·8%, 0·6%, 0·7%, 0·6%, and 0·5%, p=0.001). InterpretationMultidisciplinary patient blood management strategy significantly reduced the incidence of RBC transfusion and improved outcomes in adult patients underwent cardiac surgery. It also saved plenty of blood resources. FundingNone.