Utility and cost-effectiveness of preoperative autologous blood donation in gynecologic and gynecologic oncology patients

Abstract

OBJECTIVE: To evaluate utility and cost-effectiveness of preoperative autologous blood donation in gynecologic and gynecologic oncology patients. METHODS: Pheresis unit records were retrospectively reviewed to identify all women who performed autologous blood donation. Clinical charts were abstracted. Use rate (number of units used/number of units donated) and quality-adjusted life years were calculated. Statistical analysis consisted of χ 2, Student t, and Fisher exact tests. RESULTS: A total of 106 women with benign ( n = 63) and malignant disease ( n = 43) donated 143 units (1.4 units per patient) of which 126 (88%) were discarded. Fifteen patients (14%) were transfused a total of 24 units, 17 autologous (71%) and seven allogeneic (29%). Those transfused had a significantly higher estimated blood loss (700 mL versus 275 mL, P < .001), lower nadir hemoglobin (7.9 versus 9.6, P < .001), and longer hospital stay (4.9 days versus 4.0 days, P = .05). Despite similar estimated blood loss (370 mL versus 310 mL), the use rate for malignant versus benign disease was significantly greater (0.31 versus 0.07, P = .005). Radical versus nonradical surgery had a significantly higher estimated blood loss (620 mL versus 250 mL, P = .001) and use rate (0.26 versus 0.11, P = .001) as well. Estimated cost per quality-adjusted life years for autologous blood donation for each category exceeded $1,000,000. CONCLUSION: Autologous blood donation is an expensive medical practice and does not guarantee that exposure to allogeneic blood will not occur. If pursued, it should be directed towards those who have a known malignancy or those for whom radical surgery is anticipated. Other methods of blood conservation may be safer and more cost-effective.