A New Intraoperative Protocol for Reducing Perioperative Transfusions in Cardiac Surgery

J. Hunter Mehaffey, Sarah A. Schubert, Michael G. Gelvin, Eric J. Charles, Robert B. Hawkins, Lily E. Johnston, Gorav Ailawadi, Irving L. Kron, Leora T. Yarboro

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background Perioperative anemia and blood product transfusion increases short-term and long-term morbidity and mortality during cardiac surgery. We hypothesized that streamlined cardiopulmonary bypass circuit and rotational thromboelastometry (ROTEM) would reduce blood product usage and improve outcomes. Methods All patients with Society of Thoracic Surgeons risk scores at our institution from January 2013 to June 2015 were included. Individuals were chronologically stratified into 2 groups according to institutional changes to a streamlined bypass circuit and ROTEM-guided transfusion. Blood product transfusion, hematocrit, and observed to expected outcomes (O/E) were compared between the groups. Results Patients were defined as either control group (533 patients, 12 months) or intervention group (804 patients, 18 months). The intervention group was further subdivided into streamlined circuit (290 patients, 6 months) and ROTEM (514 patients, 12 months). Use of streamlined bypass circuit correlated with significantly reduced intraoperative transfusion of packed red blood cells (pRBCs) (23.8% versus 17.9%; p = 0.05) and platelets (28.0% versus 19.3; p = 0.01) with improvement in lowest intraoperative hematocrit (26.0 versus 26.9; p = 0.02). ROTEM was associated with a further reduction in intraoperative pRBCs (17.9% versus 11.28%; p = 0.01) and postoperative transfusion pRBCs (38.3% versus 23.5%; p = 0.02). The combination was associated with reduced intraoperative (44.6% versus 34.1; p < 0.001) and postoperative transfusions (45.6% versus 40.1; p < 0.001) in the intervention group, while maintaining a higher hematocrit at discharge (28.1 versus 29.1; p < 0.001). Finally, the intervention was associated with a statistically significant reduction in the O/E for reoperation (p = 0.003). Conclusions Use of streamlined cardiopulmonary bypass circuit and ROTEM may reduce transfusion and reoperation rates and improve perioperative anemia in cardiac surgical patients. This study demonstrates reproducible intraoperative methods for reducing blood product usage and improving outcomes.

Original languageEnglish (US)
Pages (from-to)176-181
Number of pages6
JournalAnnals of Thoracic Surgery
Volume104
Issue number1
DOIs
StatePublished - Jul 2017
Externally publishedYes

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Thrombelastography
Thoracic Surgery
Hematocrit
Erythrocyte Transfusion
Cardiopulmonary Bypass
Reoperation
Blood Transfusion
Anemia
Blood Platelets
Erythrocytes
Morbidity
Control Groups
Mortality

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Mehaffey, J. H., Schubert, S. A., Gelvin, M. G., Charles, E. J., Hawkins, R. B., Johnston, L. E., ... Yarboro, L. T. (2017). A New Intraoperative Protocol for Reducing Perioperative Transfusions in Cardiac Surgery. Annals of Thoracic Surgery, 104(1), 176-181. https://doi.org/10.1016/j.athoracsur.2016.10.032

A New Intraoperative Protocol for Reducing Perioperative Transfusions in Cardiac Surgery. / Mehaffey, J. Hunter; Schubert, Sarah A.; Gelvin, Michael G.; Charles, Eric J.; Hawkins, Robert B.; Johnston, Lily E.; Ailawadi, Gorav; Kron, Irving L.; Yarboro, Leora T.

In: Annals of Thoracic Surgery, Vol. 104, No. 1, 07.2017, p. 176-181.

Research output: Contribution to journalArticle

Mehaffey, JH, Schubert, SA, Gelvin, MG, Charles, EJ, Hawkins, RB, Johnston, LE, Ailawadi, G, Kron, IL & Yarboro, LT 2017, 'A New Intraoperative Protocol for Reducing Perioperative Transfusions in Cardiac Surgery', Annals of Thoracic Surgery, vol. 104, no. 1, pp. 176-181. https://doi.org/10.1016/j.athoracsur.2016.10.032
Mehaffey, J. Hunter ; Schubert, Sarah A. ; Gelvin, Michael G. ; Charles, Eric J. ; Hawkins, Robert B. ; Johnston, Lily E. ; Ailawadi, Gorav ; Kron, Irving L. ; Yarboro, Leora T. / A New Intraoperative Protocol for Reducing Perioperative Transfusions in Cardiac Surgery. In: Annals of Thoracic Surgery. 2017 ; Vol. 104, No. 1. pp. 176-181.
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abstract = "Background Perioperative anemia and blood product transfusion increases short-term and long-term morbidity and mortality during cardiac surgery. We hypothesized that streamlined cardiopulmonary bypass circuit and rotational thromboelastometry (ROTEM) would reduce blood product usage and improve outcomes. Methods All patients with Society of Thoracic Surgeons risk scores at our institution from January 2013 to June 2015 were included. Individuals were chronologically stratified into 2 groups according to institutional changes to a streamlined bypass circuit and ROTEM-guided transfusion. Blood product transfusion, hematocrit, and observed to expected outcomes (O/E) were compared between the groups. Results Patients were defined as either control group (533 patients, 12 months) or intervention group (804 patients, 18 months). The intervention group was further subdivided into streamlined circuit (290 patients, 6 months) and ROTEM (514 patients, 12 months). Use of streamlined bypass circuit correlated with significantly reduced intraoperative transfusion of packed red blood cells (pRBCs) (23.8{\%} versus 17.9{\%}; p = 0.05) and platelets (28.0{\%} versus 19.3; p = 0.01) with improvement in lowest intraoperative hematocrit (26.0 versus 26.9; p = 0.02). ROTEM was associated with a further reduction in intraoperative pRBCs (17.9{\%} versus 11.28{\%}; p = 0.01) and postoperative transfusion pRBCs (38.3{\%} versus 23.5{\%}; p = 0.02). The combination was associated with reduced intraoperative (44.6{\%} versus 34.1; p < 0.001) and postoperative transfusions (45.6{\%} versus 40.1; p < 0.001) in the intervention group, while maintaining a higher hematocrit at discharge (28.1 versus 29.1; p < 0.001). Finally, the intervention was associated with a statistically significant reduction in the O/E for reoperation (p = 0.003). Conclusions Use of streamlined cardiopulmonary bypass circuit and ROTEM may reduce transfusion and reoperation rates and improve perioperative anemia in cardiac surgical patients. This study demonstrates reproducible intraoperative methods for reducing blood product usage and improving outcomes.",
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AU - Schubert, Sarah A.

AU - Gelvin, Michael G.

AU - Charles, Eric J.

AU - Hawkins, Robert B.

AU - Johnston, Lily E.

AU - Ailawadi, Gorav

AU - Kron, Irving L.

AU - Yarboro, Leora T.

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N2 - Background Perioperative anemia and blood product transfusion increases short-term and long-term morbidity and mortality during cardiac surgery. We hypothesized that streamlined cardiopulmonary bypass circuit and rotational thromboelastometry (ROTEM) would reduce blood product usage and improve outcomes. Methods All patients with Society of Thoracic Surgeons risk scores at our institution from January 2013 to June 2015 were included. Individuals were chronologically stratified into 2 groups according to institutional changes to a streamlined bypass circuit and ROTEM-guided transfusion. Blood product transfusion, hematocrit, and observed to expected outcomes (O/E) were compared between the groups. Results Patients were defined as either control group (533 patients, 12 months) or intervention group (804 patients, 18 months). The intervention group was further subdivided into streamlined circuit (290 patients, 6 months) and ROTEM (514 patients, 12 months). Use of streamlined bypass circuit correlated with significantly reduced intraoperative transfusion of packed red blood cells (pRBCs) (23.8% versus 17.9%; p = 0.05) and platelets (28.0% versus 19.3; p = 0.01) with improvement in lowest intraoperative hematocrit (26.0 versus 26.9; p = 0.02). ROTEM was associated with a further reduction in intraoperative pRBCs (17.9% versus 11.28%; p = 0.01) and postoperative transfusion pRBCs (38.3% versus 23.5%; p = 0.02). The combination was associated with reduced intraoperative (44.6% versus 34.1; p < 0.001) and postoperative transfusions (45.6% versus 40.1; p < 0.001) in the intervention group, while maintaining a higher hematocrit at discharge (28.1 versus 29.1; p < 0.001). Finally, the intervention was associated with a statistically significant reduction in the O/E for reoperation (p = 0.003). Conclusions Use of streamlined cardiopulmonary bypass circuit and ROTEM may reduce transfusion and reoperation rates and improve perioperative anemia in cardiac surgical patients. This study demonstrates reproducible intraoperative methods for reducing blood product usage and improving outcomes.

AB - Background Perioperative anemia and blood product transfusion increases short-term and long-term morbidity and mortality during cardiac surgery. We hypothesized that streamlined cardiopulmonary bypass circuit and rotational thromboelastometry (ROTEM) would reduce blood product usage and improve outcomes. Methods All patients with Society of Thoracic Surgeons risk scores at our institution from January 2013 to June 2015 were included. Individuals were chronologically stratified into 2 groups according to institutional changes to a streamlined bypass circuit and ROTEM-guided transfusion. Blood product transfusion, hematocrit, and observed to expected outcomes (O/E) were compared between the groups. Results Patients were defined as either control group (533 patients, 12 months) or intervention group (804 patients, 18 months). The intervention group was further subdivided into streamlined circuit (290 patients, 6 months) and ROTEM (514 patients, 12 months). Use of streamlined bypass circuit correlated with significantly reduced intraoperative transfusion of packed red blood cells (pRBCs) (23.8% versus 17.9%; p = 0.05) and platelets (28.0% versus 19.3; p = 0.01) with improvement in lowest intraoperative hematocrit (26.0 versus 26.9; p = 0.02). ROTEM was associated with a further reduction in intraoperative pRBCs (17.9% versus 11.28%; p = 0.01) and postoperative transfusion pRBCs (38.3% versus 23.5%; p = 0.02). The combination was associated with reduced intraoperative (44.6% versus 34.1; p < 0.001) and postoperative transfusions (45.6% versus 40.1; p < 0.001) in the intervention group, while maintaining a higher hematocrit at discharge (28.1 versus 29.1; p < 0.001). Finally, the intervention was associated with a statistically significant reduction in the O/E for reoperation (p = 0.003). Conclusions Use of streamlined cardiopulmonary bypass circuit and ROTEM may reduce transfusion and reoperation rates and improve perioperative anemia in cardiac surgical patients. This study demonstrates reproducible intraoperative methods for reducing blood product usage and improving outcomes.

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