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Ionescu A, Sharma A, Kundnani NR, Mihăilescu A, David VL, Bedreag O, Săndesc D, Dinu AR, Săndesc MA, Albulescu N, Drăgoi RG. Intravenous iron infusion as an alternative to minimize blood transfusion in peri-operative patients. Sci Rep 2020; 10:18403. [PMID: 33110237 PMCID: PMC7591902 DOI: 10.1038/s41598-020-75535-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 10/14/2020] [Indexed: 01/07/2023] Open
Abstract
Despite the reported benefits of intravenous iron therapy (IVIT) for correcting iron deficiency anemia (IDA) before any major surgery and the evidence thereof, perioperative allogenic blood transfusion (ABT) practice is still considered as the only viable option by some clinicians worldwide. As ABT increases the likelihood of infections, cardiac complications, longer hospital stays and mortality among the patients, the practice of ABT should only be reserved for critical cases (Hb level < 7 g/dl). Timely iron studies and iron replenishment (oral/IV) of prospective surgical patients could help decrease the ABT practice, and prove beneficial from both the clinical and economic standpoint. Evidence based patient blood management guidelines should be developed and standardized for use by clinicians worldwide. These guidelines should include specific instructions on timely assessment of surgical patients for correction of their IDA by either oral iron supplementation, if time permits, or by using IVIT such as ferric carboxymaltose (FCM) in emergency surgeries and in patients with functional ID. This study was conducted to explore the clinical benefits of the timely administration of IV-FCM in iron-deficient preoperative patients during 2017-2018 and compare the results thereof with that of the ABT. Based on the IDA treatment plan of 2953 patients, 11.14% cases were administered IV FCM (Group 1), 11.58% cases received ABT (Group 2), while the remaining 77.27% of anemic cases received neither ABT nor IV FCM (Group 3). The results indicate that the IV FCM administration reduces the need for ABT and thus minimizes its associated side effects. The findings of our study concur with the favorable outcomes reported by the other similar studies.
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Affiliation(s)
- Alin Ionescu
- Department of Family Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Abhinav Sharma
- Department of Cardio-Vascular Rehabilitation & Family Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Nilima Rajpal Kundnani
- Department of Physiology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
| | - Alexandra Mihăilescu
- Department of Genetics, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Vlad Laurențiu David
- Department of Pediatric Surgery and Orthopedics, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Ovidiu Bedreag
- Department of Anesthesia and Intensive Care, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Dorel Săndesc
- Department of Anesthesia and Intensive Care, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Anca Raluca Dinu
- Department of Physical Medicine and Balneology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Mihai Alexandru Săndesc
- Department of Orthopedics and Traumatology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Nicolae Albulescu
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Răzvan Gabriel Drăgoi
- Department of Rehabilitation Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
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Meybohm P, Westphal S, Ravn HB, Ranucci M, Agarwal S, Choorapoikayil S, Spahn DR, Ahmed AB, Froessler B, Zacharowski K. Perioperative Anemia Management as Part of PBM in Cardiac Surgery – A Narrative Updated Review. J Cardiothorac Vasc Anesth 2020; 34:1060-1073. [DOI: 10.1053/j.jvca.2019.06.047] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/18/2019] [Accepted: 06/29/2019] [Indexed: 12/18/2022]
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Hofmann B, Kaufmann C, Stiller M, Neitzel T, Wienke A, Silber RE, Treede H. Positive impact of retrograde autologous priming in adult patients undergoing cardiac surgery: a randomized clinical trial. J Cardiothorac Surg 2018; 13:50. [PMID: 29784004 PMCID: PMC5963082 DOI: 10.1186/s13019-018-0739-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/10/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Adult cardiac surgery with extracorporeal circulation is known to be associated with increased risk of blood transfusion leading to adverse outcomes. Procedures like retrograde autologous priming (RAP) may reduce these negative side effects. This randomized prospective study was initiated to assess whether RAP using specifically designed RAP bag (Terumo) has immediate effects on patient outcome. METHODS One hundred eighteen adults undergoing elective CABG or elective aortic valve replacement were randomly assigned by a computer program into two groups: the RAP group (n = 54) in which the retrograde autologous priming was applied and the non-RAP (n = 64) group in which the same setting was used without the possibility to save priming volume. Patient demographics, preoperative characteristics and postoperative outcomes were analyzed for both groups. RESULTS The primary endpoint defined as rate of intraoperative blood transfusion was significantly reduced in the RAP-group (p = 0.04). The absolute risk reduction for RAP managed patients was 13.5 percent points. There were no significant differences in operation time and blood loss. No deaths and no myocardial infarctions were observed. The number of patients needed to treat to prevent at least one red blood cell transfusion was around 8 (NNT = 7.42). CONCLUSIONS Retrograde autologous priming is a safe and less invasive procedure which achieves clear benefits for adult cardiac surgery patients. In the light of increasing red blood cell transfusion risks and costs and the wish of patients to avoid a transfusion implementation of retrograde autologous priming is an interesting option. TRIAL REGISTRATION German Clinical Trials Register ID: DRKS00013512 , registered 04 December 2017.
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Affiliation(s)
- Britt Hofmann
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube-Strasse 40, 06120 Halle, Germany
| | - Claudia Kaufmann
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube-Strasse 40, 06120 Halle, Germany
| | - Markus Stiller
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube-Strasse 40, 06120 Halle, Germany
| | - Thomas Neitzel
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube-Strasse 40, 06120 Halle, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, 06097 Halle, Germany
| | - Rolf-Edgar Silber
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube-Strasse 40, 06120 Halle, Germany
| | - Hendrik Treede
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube-Strasse 40, 06120 Halle, Germany
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Froessler B, Rueger AM, Connolly MP. Assessing the costs and benefits of perioperative iron deficiency anemia management with ferric carboxymaltose in Germany. Risk Manag Healthc Policy 2018; 11:77-82. [PMID: 29731670 PMCID: PMC5923254 DOI: 10.2147/rmhp.s157379] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Perioperative administration of ferric carboxymaltose (FCM) was previously shown to reduce both the need for transfusions and the hospital length of stay in patients with preoperative iron deficiency anemia (IDA). In this study, we estimated the economic consequences of perioperative administration using FCM vs usual care in patients with IDA from the perspective of a German hospital using decision-analytic modeling. Materials and methods The model was populated with clinical inputs (transfusion rates, blood units transfused, hospital length of stay) from a previously reported randomized trial comparing FCM vs usual care for managing IDA patients undergoing elective abdominal surgery. We applied a hospital perspective to all costs, excluding surgery-related costs in both treatment arms. One-way sensitivity analyses were undertaken to evaluate key drivers of cost analysis. Results The average costs per case treated using FCM compared to usual care were €2,461 and €3,246, respectively, for resource expenses paid by hospital per case. This would suggest potential savings achieved with preoperative intravenous iron treatment per patient of €786 per case. A sensitivity analysis varying the key input parameters indicated the cost analysis is most sensitive to changes in the length of stay and the cost of hospitalization per day. Conclusion Perioperative administration of FCM results in cost savings to hospitals based on reduced blood transfusions and length of stay following elective abdominal surgery.
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Affiliation(s)
- Bernd Froessler
- Department of Anesthesia, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia.,Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Alexandra M Rueger
- Vifor Pharma, Munich, Germany.,Charité Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Kardiologie Campus Virchow-Klinikum, Berlin, Germany
| | - Mark P Connolly
- Unit of PharmacoEpidemiology and PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands.,Global Market Access Solutions Sàrl, St-Prex, Switzerland
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Meybohm P, Muellenbach RM, Keller H, Fichtlscherer S, Papadopoulos N, Spahn DR, Greinacher A, Zacharowski K. Patient Blood Management in der Herzchirurgie. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2017. [DOI: 10.1007/s00398-017-0168-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Kleinerüschkamp AG, Zacharowski K, Ettwein C, Müller MM, Geisen C, Weber CF, Meybohm P. [Cost analysis of patient blood management]. Anaesthesist 2016; 65:438-48. [PMID: 27160419 DOI: 10.1007/s00101-016-0152-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 01/21/2016] [Accepted: 02/18/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND Patient blood management (PBM) is a multidisciplinary approach focusing on the diagnosis and treatment of preoperative anaemia, the minimisation of blood loss, and the optimisation of the patient-specific anaemia reserve to improve clinical outcomes. Economic aspects of PBM have not yet been sufficiently analysed. OBJECTIVES The aim of this study is to analyse the costs associated with the clinical principles of PBM and the project costs associated with the implementation of a PBM program from an institutional perspective. MATERIALS AND METHODS Patient-related costs of materials and services were analysed at the University Hospital Frankfurt for 2013. Personnel costs of all major processes were quantified based on the time required to perform each step. Furthermore, general project costs of the implementation phase were determined. RESULTS Direct costs of transfusing a single unit of red blood cells can be calculated to a minimum of €147.43. PBM-associated costs varied depending on individual patient requirements. The following costs per patient were calculated: diagnosis of preoperative anaemia €48.69-123.88; treatment of preoperative anaemia (including iron-deficiency anaemia and megaloblastic anaemia) €12.61-127.99; minimising perioperative blood loss (including point-of-care diagnostics, coagulation management and cell salvage) €3.39-1,901.81; and costs associated with the optimisation of the tolerance to anaemia (including patient monitoring and volume therapy) €28.62. General project costs associated with the implementation of PBM were €24,998.24. CONCLUSIONS PBM combines various alternatives to the transfusion of red blood cells and improves clinical outcome. Costs of PBM vary from institution to institution and depend on the extent to which different aspects of PBM have been implemented. The quantification of costs associated with PBM is essential in order to assess the economic impact of PBM, and thereby, to efficiently re-allocate health care resources. Costs were determined at a single university hospital. Thus, further analyses of both the costs of transfusion and the costs of PBM-principles will be necessary to evaluate the cost-effectiveness of PBM.
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Affiliation(s)
- A G Kleinerüschkamp
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
| | - K Zacharowski
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - C Ettwein
- Dezernat 1, Finanz- und Rechnungswesen, Abteilung Operatives Controlling, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
| | - M M Müller
- DRK Blutspendedienst Baden-Württemberg Hessen, Institut für Transfusionsmedizin und Immunhämatologie, Frankfurt am Main, Deutschland
| | - C Geisen
- DRK Blutspendedienst Baden-Württemberg Hessen, Institut für Transfusionsmedizin und Immunhämatologie, Frankfurt am Main, Deutschland
| | - C F Weber
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - P Meybohm
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
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Bierbaum M, Grad MO, Wulff H, Kewenig S, Schöffski O. [Development and implementation of an integrated care pathway at the POLIKUM health centers using the example of anemia]. Internist (Berl) 2014; 55:470-7. [PMID: 24577343 DOI: 10.1007/s00108-014-3462-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Integrated treatment pathways are an appropriate means for increasing the quality of treatment and outcome via process optimization. Taking the POLIKUM Health Centers as an example, we intend to demonstrate how the implementation can be effected for the indication of anemia. METHOD The development and implementation were executed by an interdisciplinary workgroup in several workshops. In addition, the diagnoses and hemoglobin values of all patients with requests for hemograms were obtained and analyzed at two locations. RESULTS Developing the pathway required significantly greater efforts than initially planned. The biggest challenge was to adequately map the complexity of the different forms of anemia and, concomitantly, to design a pathway that can actually be realized in everyday life. Moreover, evaluation of the patient data demonstrated that there are a large number of cases where existing anemias are not reflected in the respective diagnoses. CONCLUSION While the ultimate effects of the new pathway cannot yet be assessed conclusively, it was possible to obtain valuable findings for practical use even at this point. Despite the limitations of the sample, the surprisingly high number of undetected anemias should give physicians cause for taking diagnostic measures even in patients with mild anemia.
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Affiliation(s)
- M Bierbaum
- LS für Gesundheitsmanagement, FAU Erlangen-Nürnberg, Lange Gasse 20, 90403, Nürnberg, Deutschland,
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Blut und Blutprodukte. REPETITORIUM INTENSIVMEDIZIN 2014. [PMCID: PMC7123366 DOI: 10.1007/978-3-642-44933-8_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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