Utility and Cost-Effectiveness of Preoperative Autologous Blood Donation in Gynecologic and Gynecologic Oncology Patients

Abstract

In Brief 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 χ2, 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. The use of preoperative autologous blood donation in gynecologic patients is not cost-effective.