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Lederer AK, Ittermann I, Chikhladze S, Marjanovic G, Kousoulas L. Multiple surgical revisions in patients with anastomotic leakage: A retrospective cohort analysis. Curr Probl Surg 2024; 61:101543. [PMID: 39168529 DOI: 10.1016/j.cpsurg.2024.101543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 06/07/2024] [Accepted: 06/12/2024] [Indexed: 08/23/2024]
Affiliation(s)
- Ann-Kathrin Lederer
- Center for Complementary Medicine, Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Ira Ittermann
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Sophia Chikhladze
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Goran Marjanovic
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Lampros Kousoulas
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.
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2
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Lahvic NK, Schauer SG, Higgins SS, Johannigman JA, Grathwohl KW. An Analysis of the Association of Arrival Hemoglobin With Overtransfusion at 24 Hours in a Trauma Population. Mil Med 2024:usae293. [PMID: 38913448 DOI: 10.1093/milmed/usae293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/20/2024] [Accepted: 06/10/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Hemorrhage control and resuscitative concepts have evolved in recent years, leading to aggressive use of blood products in trauma patients. There is subsequently a potential risk for overtransfusion, adverse effects, and waste associated with unnecessary transfusion. Methods for conserving blood products are of particular importance in future large-scale combat operations where supply chains are likely to be strained. This study examined the association of emergency department (ED) arrival hemoglobin (HGB) with overtransfusion among survivors at 24 hours after major trauma at a military trauma center. MATERIALS AND METHODS We performed a retrospective cohort study of patients who had a "major trauma" activation and received any red blood cells. Overtransfusion was defined as a HGB level ≥11.0 g/dL at 24 hours (outcome variable). Multivariable logistic regression statistics were used to compare groups and adjust for confounders (injury severity score, arrival modified shock index, injury type, age, and gender). A receiver operating characteristic was constructed with overtransfusion at 24 hours as the outcome (binary) and arrival HGB (continuous) as the independent variable. RESULTS A total of 382 patients met inclusion criteria. Overtransfusion occurred in 30.4% (n = 116) of patients, with mean ED HGB levels of 13.2 g/dL (12.9 to 13.6) versus 11.6 g/dL (11.3 to 11.8, P < .001). Receiver operating characteristic analysis showed that ED HGB was highly sensitive (0.931) for predicting 24-hour overtransfusion. In our multivariable logistic regression analysis, when adjusting for injury severity score, arrival modified shock index, injury type, age, and gender, we found that the ED HGB value had a per-unit odds ratio of 1.60 (95% CI, 1.38 to 1.86) for 24-hour overtransfusion. Hospital and intensive care unit length of stay, mechanical ventilator days, and mortality did not increase. CONCLUSION We found that the arrival HGB value was associated with overtransfusion among 24-hour survivors in a civilian trauma setting. Our findings will inform future prospective studies that investigate blood sparing clinical practice guidelines.
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Affiliation(s)
| | - Steven G Schauer
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
- US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Sophie S Higgins
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | | | - Kurt W Grathwohl
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
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3
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Kim HK, Kim HS, Noh GT, Nam JH, Chung SS, Kim KH, Lee RA. Is restrictive transfusion sufficient in colorectal cancer surgery? A retrospective study before and during the COVID-19 pandemic in Korea. Ann Coloproctol 2023; 39:493-501. [PMID: 38185948 PMCID: PMC10781603 DOI: 10.3393/ac.2023.00437.0062] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/06/2023] [Accepted: 09/18/2023] [Indexed: 01/09/2024] Open
Abstract
PURPOSE Blood transfusion is one of the most common procedures used to treat anemia in colorectal surgery. Despite controversy regarding the adverse effects of blood products, surgeons have maintained standards for administering blood transfusions. However, this trend was restrictive during the COVID-19 pandemic because of a shortage of blood products. In this study, we conducted an analysis to investigate whether the restriction of blood transfusions affected postoperative surgical outcomes. METHODS Medical records of 318 patients who underwent surgery for colon and rectal cancer at Ewha Womans University Mokdong Hospital between June 2018 and March 2022 were reviewed retrospectively. The surgical outcomes between the liberal and restrictive transfusion strategies in pre- and post-COVID-19 groups were analyzed. RESULTS In univariate analysis, postoperative transfusion was associated with infectious complications (odds ratio [OR], 1.705; 95% confidence interval [CI], 1.015-2.865; P=0.044). However, postoperative transfusion was not an independent risk factor for the development of infectious complications in multivariate analysis (OR, 1.305; 95% CI, 0.749-2.274; P=0.348). In subgroup analysis, there was no significant association between infectious complications and the hemoglobin threshold level for the administration of a transfusion (OR, 1.249; 95% CI, 0.928-1.682; P=0.142). CONCLUSION During colorectal surgery, the decision to perform a blood transfusion is an important step in ensuring favorable surgical outcomes. According to the results of this study, restrictive transfusion is sufficient for favorable surgical outcomes compared with liberal transfusion. Therefore, modification of guidelines is suggested to minimize unnecessary transfusion-related side effects and prevent the overuse of blood products.
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Affiliation(s)
- Hyeon Kyeong Kim
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ho Seung Kim
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Gyoung Tae Noh
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jin Hoon Nam
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Soon Sup Chung
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Kwang Ho Kim
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ryung-Ah Lee
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
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4
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Moreillon B, Krumm B, Saugy JJ, Saugy M, Botrè F, Vesin JM, Faiss R. Prediction of plasma volume and total hemoglobin mass with machine learning. Physiol Rep 2023; 11:e15834. [PMID: 37828664 PMCID: PMC10570407 DOI: 10.14814/phy2.15834] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/12/2023] [Accepted: 09/12/2023] [Indexed: 10/14/2023] Open
Abstract
Hemoglobin concentration ([Hb]) is used for the clinical diagnosis of anemia, and in sports as a marker of blood doping. [Hb] is however subject to significant variations mainly due to shifts in plasma volume (PV). This study proposes a newly developed model able to accurately predict total hemoglobin mass (Hbmass) and PV from a single complete blood count (CBC) and anthropometric variables in healthy subject. Seven hundred and sixty-nine CBC coupled to measures of Hbmass and PV using a CO-rebreathing method were used with a machine learning tool to calculate an estimation model. The predictive model resulted in a root mean square error of 33.2 g and 35.6 g for Hbmass, and 179 mL and 244 mL for PV, in women and men, respectively. Measured and predicted data were significantly correlated (p < 0.001) with a coefficient of determination (R2 ) ranging from 0.76 to 0.90 for Hbmass and PV, in both women and men. The Bland-Altman bias was on average 0.23 for Hbmass and 4.15 for PV. We herewith present a model with a robust prediction potential for Hbmass and PV. Such model would be relevant in providing complementary data in contexts such as the epidemiology of anemia or the individual monitoring of [Hb] in anti-doping.
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Affiliation(s)
- B. Moreillon
- Research and Expertise in anti‐Doping Sciences (REDs), Institute of Sport SciencesUniversity of LausanneLausanneSwitzerland
- Union Cycliste InternationaleWorld Cycling CentreAigleSwitzerland
| | - B. Krumm
- Research and Expertise in anti‐Doping Sciences (REDs), Institute of Sport SciencesUniversity of LausanneLausanneSwitzerland
| | - J. J. Saugy
- Research and Expertise in anti‐Doping Sciences (REDs), Institute of Sport SciencesUniversity of LausanneLausanneSwitzerland
| | - M. Saugy
- Research and Expertise in anti‐Doping Sciences (REDs), Institute of Sport SciencesUniversity of LausanneLausanneSwitzerland
| | - F. Botrè
- Research and Expertise in anti‐Doping Sciences (REDs), Institute of Sport SciencesUniversity of LausanneLausanneSwitzerland
- Laboratorio AntidopingFederazione Medico Sportiva ItalianaRomeItaly
| | - J. M. Vesin
- Signal Processing Laboratory 2Swiss Federal Institute of TechnologyLausanneSwitzerland
| | - R. Faiss
- Research and Expertise in anti‐Doping Sciences (REDs), Institute of Sport SciencesUniversity of LausanneLausanneSwitzerland
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5
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Capdevila X, Lasocki S, Duchalais A, Rigal JC, Mertl P, Ghewy P, Farizon F, Lanz T, Buckert A, Belarbia S, Trochu JN, Cacoub P. Perioperative Iron Deficiency in Patients Scheduled for Major Elective Surgeries: A French Prospective Multicenter Cross-Sectional Study. Anesth Analg 2023; 137:322-331. [PMID: 36881542 DOI: 10.1213/ane.0000000000006445] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
BACKGROUND The management of perioperative iron deficiency is a component of the concept of patient blood management. The objective of this study was to update French data on the prevalence of iron deficiency in patients scheduled for major surgery. METHODS The CARENFER PBM study was a prospective cross-sectional study in 46 centers specialized in orthopedic, cardiac, urologic/abdominal, or gynecological surgery. The primary end point was the prevalence of iron deficiency at the time of surgery (D-1/D0) defined as serum ferritin <100 µg/L and/or transferrin saturation (TSAT) <20%. RESULTS A total of 1494 patients (mean age, 65.7 years; women, 49.3%) were included from July 20, 2021 to January 3, 2022. The prevalence of iron deficiency in the 1494 patients at D-1/D0 was 47.0% (95% confidence interval [CI], 44.5-49.5). At 30 days after surgery, the prevalence of iron deficiency was 45.0% (95% CI, 42.0-48.0) in the 1085 patients with available data. The percentage of patients with anemia and/or iron deficiency increased from 53.6% at D-1/D0 to 71.3% at D30 ( P < .0001), mainly due to the increase of patients with both anemia and iron deficiency (from 12.2% at D-1/D0 to 32.4% at D30; P < .0001). However, a treatment of anemia and/or iron deficiency was administered preoperatively to only 7.7% of patients and postoperatively to 21.7% (intravenous iron, 14.2%). CONCLUSIONS Iron deficiency was present in half of patients scheduled for major surgery. However, few treatments to correct iron deficiency were implemented preoperatively or postoperatively. There is an urgent need for action to improve these outcomes, including better patient blood management.
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Affiliation(s)
- Xavier Capdevila
- From the Department of Anesthesiology and Intensive Care Medicine, Lapeyronie University Hospital, Montpellier University, School of Medicine, Montpellier, France
- Basic Science Research Unit, INSERM UMR U1298, NeuroSciences Institute, Montpellier, France
| | | | | | - Jean-Christophe Rigal
- Service d'anesthésie et de réanimation chirurgicale, Hôpital Guillaume et René Laënnec, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Patrice Mertl
- Service d'orthopédie et traumatologie, CHU Amiens-Picardie, Amiens, France
| | - Pierre Ghewy
- Pôle d'anesthésie-réanimation, CHU de Lille, Lille, France
| | - Frédéric Farizon
- Department of Orthopedic Surgery, University Hospital Centre of Saint-Etienne, Hôpital Nord, Saint-Étienne, France
| | - Thomas Lanz
- Anesthésie-Réanimation, Clinique de la Sauvegarde, Lyon, France
| | - Axel Buckert
- Anesthésie-Réanimation, Hôpital Privé NATECIA, Avenue Rockefeller, Lyon, France
| | - Samia Belarbia
- Service d'anesthésie et de réanimation chirurgicale, Hôpital Guillaume et René Laënnec, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Jean-Noël Trochu
- INSERM, Institut du Thorax, CNRS, University Hospital of Nantes, University of Nantes, Nantes, Franceand
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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6
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Hindawi S. Patient Blood Management: Why We Need to Change. Transfusion 2023; 63 Suppl 1:S1-S2. [PMID: 36468675 DOI: 10.1111/trf.17211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Salwa Hindawi
- Saudi Society of Transfusion Medicine & Services, Saudi Arabia
- Haematology Department, Faculity of Medicine at King Abdulaziz University, Jeddah, Saudi Arabia
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7
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O'Shaughnessy S, Tangel V, Chaturvedi R, Javaid A, White R, Hoyler MM. Medicare and Medicaid insurance status is associated with increased allogeneic red blood cell transfusion in cardiac surgery patients: 2007-2018. J Card Surg 2022; 37:5162-5171. [PMID: 36378897 DOI: 10.1111/jocs.17168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIM Allogeneic red blood cell (RBC) transfusion and health insurance status are independently associated with perioperative morbidity. The aim of this study was to evaluate the effect of insurance status on allogeneic and autologous transfusion risk in cardiac surgery patients. METHODS We conducted a retrospective observational study of data spanning 2007-2018 from six states from the State Inpatient Databases. Patients were cohorted by medical insurance type. Rates and risk-adjusted odds ratios (aOR) were calculated for allogenic and autologous RBC transfusions. Interactions between insurance and race/ethnicity were assessed. RESULTS A total of 710,296 cardiac surgery patients were included. Allogeneic infusions occurred in 34.7% of Medicare patients, 31.9% of Medicaid patients, 24.7% of privately insured patients, and 26.1% of uninsured patients. Autologous rates were 2.3%, 2.5%, 3.4%, and 2.6% for Medicare, Medicaid, privately insured, and uninsured patients, respectively. Medicare and Medicaid patients were more likely to receive allogeneic RBC than privately insured patients (Medicare: aOR: 1.42, 99% confidence interval [CI]: 1.40-1.44, p < .001, Medicaid: aOR: 1.18, 99% CI: 1.14-1.21, p < .001). Nonwhite Medicare patients showed higher odds of allogeneic transfusion compared with White patients with private insurance (Black Medicare: aOR 1.74, 99% CI: 1.65-1.83, p < .001, Hispanic Medicare: aOR 1.92, 99% CI: 1.84-2.00, p < .001). CONCLUSION Cardiac surgery patients with Medicare and Medicaid insurance demonstrate increased risk of allogeneic RBC transfusion; nonwhite patient groups are particularly vulnerable. Further research is needed to understand the causes and implications of these disparities, and to help ensure equitable care across patient groups.
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Affiliation(s)
- Sinead O'Shaughnessy
- Department of Anesthesiology, Weill Cornell Medicine, New York City, New York, USA
| | - Virginia Tangel
- Department of Anesthesiology, Weill Cornell Medicine, New York City, New York, USA
| | - Rahul Chaturvedi
- Department of Anesthesiology, Weill Cornell Medicine, New York City, New York, USA
| | - Amal Javaid
- Department of Anesthesiology, Weill Cornell Medicine, New York City, New York, USA
| | - Robert White
- Department of Anesthesiology, Weill Cornell Medicine, New York City, New York, USA
| | - Marguerite M Hoyler
- Department of Anesthesiology, Weill Cornell Medicine, New York City, New York, USA
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8
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Delgado C, Komatsu R. Patient Blood Management programs for post-partum hemorrhage. Best Pract Res Clin Anaesthesiol 2022; 36:359-369. [PMID: 36513431 DOI: 10.1016/j.bpa.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/08/2022] [Indexed: 12/15/2022]
Abstract
Patient blood management (PBM) strategies aim to maintain hemoglobin concentration, optimize hemostasis, and minimize blood loss to improve patient outcomes. Because postpartum hemorrhage (PPH) is a leading cause of maternal mortality and blood product utilization, PBM principles can be applied in its therapeutic approach. First, pre-operative identification of risk factors for PPH and identification of peri-delivery anemia should be conducted. Iron supplementation should be used to optimize hemoglobin concentration before delivery; it can also be used to treat anemia in the postpartum period after severe PPH. Both acute normovolemic hemodilution and intraoperative cell salvage can be effective techniques to reduce allogeneic blood transfusion during or after surgical procedures. Furthermore, these strategies appear to be safe when used in the pregnant population.
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Affiliation(s)
- Carlos Delgado
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific Street, Box 356340, Seattle, WA 98195, USA.
| | - Ryu Komatsu
- Department of General Anesthesiology and Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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POLESE F, MANIA D, ARREGHINI N, MAZZAROL G, MALATESTA R, GESSONI G. Patient blood management negli interventi per protesi d'anca: una virtuosa partnership pubblico-privato. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2022. [DOI: 10.23736/s0393-3660.20.04476-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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O'Shaughnessy S, Tangel V, Dzotsi S, Jiang S, White R, Hoyler M. Non-White Race/Ethnicity and Female Sex Are Associated with Increased Allogeneic Red Blood Cell Transfusion in Cardiac Surgery Patients: 2007-2018. J Cardiothorac Vasc Anesth 2022; 36:1908-1918. [PMID: 34969561 DOI: 10.1053/j.jvca.2021.11.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/11/2021] [Accepted: 11/14/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate racial and/or ethnic and sex disparities in allogeneic and autologous red blood cell (RBC) transfusions in cardiac surgery. DESIGN A retrospective observational study. SETTING 2007 to 2018 data from FL, MD, KY, WA, NY, and CA from the State Inpatient Databases (SID), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. PARTICIPANTS A total of 710,296 inpatients who underwent elective or emergency coronary artery bypass grafting (CABG), cardiac valve surgery,or combination CABG and/or valve surgery. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Patients were cohorted by race and/or ethnicity and sex, as defined by SID-HCUP. Demographic characteristics and comorbidities were compared. Rates and risk-adjusted odds ratios (aOR) were calculated for allogeneic and autologous RBC transfusion (primary outcomes). Additional secondary analyses were conducted for in-hospital mortality, 30-day readmission, 90-day readmission, hospital length of stay, and total charges to examine the effect of RBC transfusion status. Effect modification between race and sex was assessed. When controlling for patient demographics, comorbidities, and hospital characteristics, non-White patients were more likely to receive an allogeneic RBC transfusion during cardiac surgery than White patients (Black: aOR 1.17, 99% CI 1.13-1.20, p < 0.001, Hispanic: aOR 1.22, 99% CI 1.19-1.22, p < 0.001). Women were more likely to receive allogeneic RBC than men (aOR 1.69, 99% CI 1.66-1.72, p < 0.001). In interaction models, non-White women had the highest odds of allogeneic blood transfusion as compared to White men (reference category; Black women: aOR 2.04, 99% CI 1.91-2.17, p < 0.001, Hispanic women: aOR 2.03, 99% CI 1.90-2.16, p < 0.001). CONCLUSION These findings highlighted the differences in the rates of allogeneic RBC transfusion for non-White and female patients undergoing cardiac surgery, which is a well-established marker of poorer outcomes.
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Affiliation(s)
- Sinead O'Shaughnessy
- Weill Cornell Medicine, Department of Anesthesiology, 525 East 68th Street, New York City, NY.
| | - Virginia Tangel
- Weill Cornell Medicine, Department of Anesthesiology, 525 East 68th Street, New York City, NY
| | - Safiya Dzotsi
- Weill Cornell Medicine, Department of Anesthesiology, 525 East 68th Street, New York City, NY
| | - Silis Jiang
- Weill Cornell Medicine, Department of Anesthesiology, 525 East 68th Street, New York City, NY
| | - Robert White
- Weill Cornell Medicine, Department of Anesthesiology, 525 East 68th Street, New York City, NY
| | - Marguerite Hoyler
- Weill Cornell Medicine, Department of Anesthesiology, 525 East 68th Street, New York City, NY
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Briguglio M, Perazzo P, Langella F, Crespi T, De Vecchi E, Riso P, Porrini M, Scaramuzzo L, Bassani R, Brayda-Bruno M, Banfi G, Berjano P. Prediction of Long-Term Recovery From Disability Using Hemoglobin-Based Models: Results From a Cohort of 1,392 Patients Undergoing Spine Surgery. Front Surg 2022; 9:850342. [PMID: 35372461 PMCID: PMC8966424 DOI: 10.3389/fsurg.2022.850342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/17/2022] [Indexed: 11/13/2022] Open
Abstract
Hemoglobin and its associated blood values are important laboratory biomarkers that mirror the strength of constitution of patients undergoing spine surgery. Along with the clinical determinants available during the preadmission visit, it is important to explore their potential for predicting clinical success from the patient's perspective in order to make the pre-admission visit more patient-centered. We analyzed data from 1,392 patients with spine deformity, disc disease, or spondylolisthesis enrolled between 2016 and 2019 in our institutional Spine Registry. Patient-reported outcome measure at 17 months after surgery was referred to the Oswestry disability index. High preoperative hemoglobin was found to be the strongest biochemical determinant of clinical success along with high red blood cells count, while low baseline disability, prolonged hospitalization, and long surgical times were associated with poor recovery. The neural network model of these predictors showed a fair diagnostic performance, having an area under the curve of 0.726 and a sensitivity of 86.79%. However, the specificity of the model was 15.15%, thus providing to be unreliable in forecasting poor patient-reported outcomes. In conclusion, preoperative hemoglobin may be one of the key biomarkers on which to build appropriate predictive models of long-term recovery after spine surgery, but it is necessary to include multidimensional variables in the models to increase the reliability at the patient's level.
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Affiliation(s)
- Matteo Briguglio
- IRCCS Orthopedic Institute Galeazzi, Scientific Direction, Milan, Italy
- *Correspondence: Matteo Briguglio
| | - Paolo Perazzo
- IRCCS Orthopedic Institute Galeazzi, Intensive Care Unit, Milan, Italy
| | | | - Tiziano Crespi
- IRCCS Orthopedic Institute Galeazzi, Intensive Care Unit, Milan, Italy
| | - Elena De Vecchi
- IRCCS Orthopedic Institute Galeazzi, Laboratory of Clinical Chemistry and Microbiology, Milan, Italy
| | - Patrizia Riso
- University of Milan, Department of Food, Environmental and Nutritional Sciences, Division of Human Nutrition, Milan, Italy
| | - Marisa Porrini
- University of Milan, Department of Food, Environmental and Nutritional Sciences, Division of Human Nutrition, Milan, Italy
| | | | - Roberto Bassani
- IRCCS Orthopedic Institute Galeazzi, Spine Unit 2, Milan, Italy
| | | | - Giuseppe Banfi
- IRCCS Orthopedic Institute Galeazzi, Scientific Direction, Milan, Italy
- Vita-Salute San Raffaele University, Faculty of Medicine and Surgery, Milan, Italy
| | - Pedro Berjano
- IRCCS Orthopedic Institute Galeazzi, GSpine 4, Milan, Italy
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12
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Lampe B, Luengas-Würzinger V, Weitz J, Roth S, Rawert F, Schuler E, Classen-von Spee S, Fix N, Baransi S, Dizdar A, Mallmann P, Schaser KD, Bogner A. Opportunities and Limitations of Pelvic Exenteration Surgery. Cancers (Basel) 2021; 13:6162. [PMID: 34944783 PMCID: PMC8699210 DOI: 10.3390/cancers13246162] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/26/2021] [Accepted: 12/03/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The practice of exenterative surgery is sometimes controversial and has garnered a certain scepticism. Surgical studies are difficult to conduct due to insufficient data. The aim of this review is to present the current standing of pelvic exenteration from a surgical, gynaecological and urological point of view. METHODS This review is based upon a literature review (MEDLINE (PubMed), CENTRAL (Cochrane) and EMBASE (Elsevier)) of retrospective studies on exenterative surgery from 1993-2020. Using MeSH (Medical Subject Headings) search terms, 1572 publications were found. These were evaluated and screened with respect to their eligibility using algorithms and well-defined inclusion and exclusion criteria. Therefore, the guidelines for systematic reviews (PRISMA) were used. RESULTS A complete tumour resection (R0) often represents the only curative option for advanced pelvic carcinomas and their recurrences. A recent systematic review showed significant symptom relief in 80% of palliative patients after pelvic exenteration. Surgical limitations (distant metastases, involvement of the pelvic wall, etc.) are diminished by adequate surgical expertise and close interdisciplinary cooperation. While the mortality rate is low (2-5%), the still relatively high morbidity rate (32-84%) can be minimized by optimizing the perioperative setting. Following exenterations, roughly 79-82% of patients report satisfying results according to PROs (patient-reported outcomes). CONCLUSION Due to multimodality treatment strategies combined with extended surgical expertise and patients' preferences, pelvic exenteration can be offered nowadays with low mortality and acceptable postoperative quality of life. The possibilities of surgical treatment are often underestimated. A multi-centre database (PelvEx Collaborative) was established to collect data and experiences to optimize the research in this field.
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Affiliation(s)
- Björn Lampe
- Department of Gynecology & Obstetrics, Florence Nightingale Hospital, Kreuzbergstr. 79, 40489 Düsseldorf, Germany; (B.L.); (F.R.); (E.S.); (S.C.-v.S.); (N.F.); (S.B.); (A.D.)
| | - Verónica Luengas-Würzinger
- Department of Gynecology & Obstetrics, Florence Nightingale Hospital, Kreuzbergstr. 79, 40489 Düsseldorf, Germany; (B.L.); (F.R.); (E.S.); (S.C.-v.S.); (N.F.); (S.B.); (A.D.)
| | - Jürgen Weitz
- Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany; (J.W.); (A.B.)
| | - Stephan Roth
- Department of Urology and Pediatric Urology, Helios Faculty of Medicine Wuppertal, Universität Witten/Herdecke, Heusnerstraße 40, 42283 Wuppertal, Germany;
| | - Friederike Rawert
- Department of Gynecology & Obstetrics, Florence Nightingale Hospital, Kreuzbergstr. 79, 40489 Düsseldorf, Germany; (B.L.); (F.R.); (E.S.); (S.C.-v.S.); (N.F.); (S.B.); (A.D.)
| | - Esther Schuler
- Department of Gynecology & Obstetrics, Florence Nightingale Hospital, Kreuzbergstr. 79, 40489 Düsseldorf, Germany; (B.L.); (F.R.); (E.S.); (S.C.-v.S.); (N.F.); (S.B.); (A.D.)
| | - Sabrina Classen-von Spee
- Department of Gynecology & Obstetrics, Florence Nightingale Hospital, Kreuzbergstr. 79, 40489 Düsseldorf, Germany; (B.L.); (F.R.); (E.S.); (S.C.-v.S.); (N.F.); (S.B.); (A.D.)
| | - Nando Fix
- Department of Gynecology & Obstetrics, Florence Nightingale Hospital, Kreuzbergstr. 79, 40489 Düsseldorf, Germany; (B.L.); (F.R.); (E.S.); (S.C.-v.S.); (N.F.); (S.B.); (A.D.)
| | - Saher Baransi
- Department of Gynecology & Obstetrics, Florence Nightingale Hospital, Kreuzbergstr. 79, 40489 Düsseldorf, Germany; (B.L.); (F.R.); (E.S.); (S.C.-v.S.); (N.F.); (S.B.); (A.D.)
| | - Anca Dizdar
- Department of Gynecology & Obstetrics, Florence Nightingale Hospital, Kreuzbergstr. 79, 40489 Düsseldorf, Germany; (B.L.); (F.R.); (E.S.); (S.C.-v.S.); (N.F.); (S.B.); (A.D.)
| | - Peter Mallmann
- Department of Obstetrics and Gynecology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany;
| | - Klaus-Dieter Schaser
- University Center for Orthopedics, Trauma and Plastic Surgery, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany;
| | - Andreas Bogner
- Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany; (J.W.); (A.B.)
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13
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Abstract
Red blood cell (RBC) transfusions are necessary to increase a patient's oxygen carrying capacity. The optimal transfusion trigger remains elusive, but a restrictive transfusion trigger of 7 g/dL has been shown in studies to reduce RBC transfusions without adversely affecting patient outcomes. Patient blood management programs have been shown effective at reducing RBC transfusions. Hemoglobin-based oxygen carriers and induced pluripotent stem cell derived RBCs are being developed to help mitigate RBC shortages and RBC transfusion limitations. Numerous challenges still exist that need to be overcome before they can have widespread clinical use.
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Affiliation(s)
- Yvette C Tanhehco
- Division of Transfusion Medicine, Department of Pathology and Cell Biology, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, Harkness Pavilion 4-418A, New York, NY 10032, USA. https://twitter.com/YTanhehcoPhDMD
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14
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Hamilton CM, Davenport DL, Bernard AC. Demonstration of a U.S. nationwide reduction in transfusion in general surgery and a review of published transfusion reduction methodologies. Transfusion 2021; 61:3119-3128. [PMID: 34595745 DOI: 10.1111/trf.16677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 06/24/2021] [Accepted: 08/04/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Red blood cell transfusions in surgical procedures can be lifesaving. However, recent studies show transfusions are associated with a dose-dependent increase in postoperative morbidity and mortality; hospitals and physicians have attempted to reduce them. We sought to determine the success of these efforts and review and summarize published reduction methods employed. STUDY DESIGN/METHODS An analysis of transfusion data from ACS-NSQIP public use files of general surgical procedures for 2012 and 2018; a retrospective review of the literature surrounding general surgical transfusion reduction from 2008 to 2018. RESULTS The rate of general surgical transfusion in the NSQIP dataset decreased from 5.5% in 2012 to 4.0% in 2018, a 27% relative reduction in transfusion. After extensive multivariable adjustment for patient risk and operative complexity, this effect remained (Odds ratio 0.65, 95% CI 0.63-0.67, p < .001). Furthermore, there was a positive correlation between specific procedure decreases in transfusion and decreases in 30-day morbidity (rho =0.41, p = .003) and mortality (rho = 0.37, p = .007). There were 866 published studies matching our search term "red blood cell transfusion reduction." Forty-four were relevant to general surgery. Seven dominant strategies for transfusion reduction by descending frequency of report included restrictive transfusion thresholds, management of preoperative anemia, perioperative interventions, educational programs, electronic clinical decision support, waste reduction, and audits of transfusion practices. CONCLUSION Our study demonstrates a 27% decrease in general surgery transfusion between 2012 and 2018 with associated reductions in morbidity and mortality, suggesting published employed strategies have been successful and safely implemented.
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Affiliation(s)
| | | | - Andrew C Bernard
- Department of Surgery, University of Kentucky, Lexington, Kentucky, USA
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15
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Foster M, Presseau J, Podolsky E, McIntyre L, Papoulias M, Brehaut JC. How well do critical care audit and feedback interventions adhere to best practice? Development and application of the REFLECT-52 evaluation tool. Implement Sci 2021; 16:81. [PMID: 34404449 PMCID: PMC8369748 DOI: 10.1186/s13012-021-01145-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/24/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Healthcare Audit and Feedback (A&F) interventions have been shown to be an effective means of changing healthcare professional behavior, but work is required to optimize them, as evidence suggests that A&F interventions are not improving over time. Recent published guidance has suggested an initial set of best practices that may help to increase intervention effectiveness, which focus on the "Nature of the desired action," "Nature of the data available for feedback," "Feedback display," and "Delivering the feedback intervention." We aimed to develop a generalizable evaluation tool that can be used to assess whether A&F interventions conform to these suggestions for best practice and conducted initial testing of the tool through application to a sample of critical care A&F interventions. METHODS We used a consensus-based approach to develop an evaluation tool from published guidance and subsequently applied the tool to conduct a secondary analysis of A&F interventions. To start, the 15 suggestions for improved feedback interventions published by Brehaut et al. were deconstructed into rateable items. Items were developed through iterative consensus meetings among researchers. These items were then piloted on 12 A&F studies (two reviewers met for consensus each time after independently applying the tool to four A&F intervention studies). After each consensus meeting, items were modified to improve clarity and specificity, and to help increase the reliability between coders. We then assessed the conformity to best practices of 17 critical care A&F interventions, sourced from a systematic review of A&F interventions on provider ordering of laboratory tests and transfusions in the critical care setting. Data for each criteria item was extracted by one coder and confirmed by a second; results were then aggregated and presented graphically or in a table and described narratively. RESULTS In total, 52 criteria items were developed (38 ratable items and 14 descriptive items). Eight studies targeted lab test ordering behaviors, and 10 studies targeted blood transfusion ordering. Items focused on specifying the "Nature of the Desired Action" were adhered to most commonly-feedback was often presented in the context of an external priority (13/17), showed or described a discrepancy in performance (14/17), and in all cases it was reasonable for the recipients to be responsible for the change in behavior (17/17). Items focused on the "Nature of the Data Available for Feedback" were adhered to less often-only some interventions provided individual (5/17) or patient-level data (5/17), and few included aspirational comparators (2/17), or justifications for specificity of feedback (4/17), choice of comparator (0/9) or the interval between reports (3/13). Items focused on the "Nature of the Feedback Display" were reported poorly-just under half of interventions reported providing feedback in more than one way (8/17) and interventions rarely included pilot-testing of the feedback (1/17 unclear) or presentation of a visual display and summary message in close proximity of each other (1/13). Items focused on "Delivering the Feedback Intervention" were also poorly reported-feedback rarely reported use of barrier/enabler assessments (0/17), involved target members in the development of the feedback (0/17), or involved explicit design to be received and discussed in a social context (3/17); however, most interventions clearly indicated who was providing the feedback (11/17), involved a facilitator (8/12) or involved engaging in self-assessment around the target behavior prior to receipt of feedback (12/17). CONCLUSIONS Many of the theory-informed best practice items were not consistently applied in critical care and can suggest clear ways to improve interventions. Standardized reporting of detailed intervention descriptions and feedback templates may also help to further advance research in this field. The 52-item tool can serve as a basis for reliably assessing concordance with best practice guidance in existing A&F interventions trialed in other healthcare settings, and could be used to inform future A&F intervention development. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Madison Foster
- School of Epidemiology and Public Health, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.,Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, General Campus, 501 Smyth Road, Centre for Practice Changing Research, Box 201B, Ottawa, ON, K1H 8L6, Canada
| | - Justin Presseau
- School of Epidemiology and Public Health, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.,Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, General Campus, 501 Smyth Road, Centre for Practice Changing Research, Box 201B, Ottawa, ON, K1H 8L6, Canada.,School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Vanier Hall, Ottawa, ON, K1N 6N5, Canada
| | - Eyal Podolsky
- School of Epidemiology and Public Health, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Lauralyn McIntyre
- School of Epidemiology and Public Health, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.,Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, General Campus, 501 Smyth Road, Centre for Practice Changing Research, Box 201B, Ottawa, ON, K1H 8L6, Canada.,Department of Critical Care Medicine, The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Maria Papoulias
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, General Campus, 501 Smyth Road, Centre for Practice Changing Research, Box 201B, Ottawa, ON, K1H 8L6, Canada
| | - Jamie C Brehaut
- School of Epidemiology and Public Health, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada. .,Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, General Campus, 501 Smyth Road, Centre for Practice Changing Research, Box 201B, Ottawa, ON, K1H 8L6, Canada.
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16
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Jensen KS, Masser BM, Davison TE, Van Dyke N, France JL, France CR. Assessing the impact of an automated Web-based motivational interview on the intention and return behavior of Australian O-negative donors. Transfusion 2020; 61:1122-1133. [PMID: 33368393 DOI: 10.1111/trf.16234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/22/2020] [Accepted: 11/22/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND O-negative donors are a critical resource for blood collection agencies, and their recruitment and retention provides an ongoing challenge. Motivational interviewing shows promise as a tool to promote donor retention, although concerns about scalability remain. The current study examined the effect of an automated Web-based interview drawing on motivational interviewing and self-determination theory on O-negative donors' motivation, intention, and behavior. STUDY DESIGN AND METHODS Within 13 days of donating, 2820 O-negative donors completed baseline measures of motivation and intention before being randomly assigned to complete either a motivational interview (MI) or active control interview (ACI). Motivation and intention were assessed at 2 days and at 7 weeks after participation in the MI or ACI, with return behavior tracked for 6 months following trial completion. RESULTS Changes in donor motivation and intention, rate, and time to return did not vary by participation in the MI or ACI. When compared with O-negative donors who experienced business-as-usual practices, donors completing the MI or ACI returned to donate more, and they returned more quickly. However, subsequent exploratory analyses considering the behavior of those who did not accept the invitation to participate and those who completed only baseline measures showed that the improved return behavior of donors in the MI or ACI conditions was likely not due to any specific properties of the MI or ACI activities. CONCLUSIONS Australian O-negative donors were highly internally motivated and committed to donating. An automated Web-based motivational interview appears to be of limited effectiveness in promoting the return of such donors.
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Affiliation(s)
- Kyle S Jensen
- Research and Development, Australian Red Cross Lifeblood, Kelvin Grove, Queensland, Australia
| | - Barbara M Masser
- Research and Development, Australian Red Cross Lifeblood, Kelvin Grove, Queensland, Australia.,School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Tanya E Davison
- Research and Development, Australian Red Cross Lifeblood, St Kilda, Victoria, Australia
| | - Nina Van Dyke
- Research and Development, Australian Red Cross Lifeblood, St Kilda, Victoria, Australia
| | - Janis L France
- Department of Psychology, Ohio University, Athens, Ohio, USA
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17
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Al-Riyami AZ, Louw VJ, Indrikovs AJ, Nedelcu E, Bakhtary S, Eichbaum QG, Smit Sibinga CT. Global survey of transfusion medicine curricula in medical schools: Challenges and opportunities. Transfusion 2020; 61:617-626. [PMID: 33091965 PMCID: PMC7894143 DOI: 10.1111/trf.16147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/13/2020] [Accepted: 09/20/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Physician's knowledge in transfusion medicine (TM) is critical for patient safety. Therefore, ensuring that medical schools provide adequate education in TM is important. The aim of this study was to assess the status of TM education at a global level. STUDY DESIGN AND METHODS A comprehensive anonymous survey to assess TM education in existing medical school curricula was developed. The survey was distributed to deans and educational leads of medical schools in a range of low-, medium-, high-, and very high-human development index (HDI) countries. It included 20 questions designed to assess specific domains including structure of TM curriculum and teaching faculty. RESULTS The response rate was 53%. The majority of responding schools from very-high-HDI countries offered a 6-year curriculum after high school or a 4-year curriculum after college education, whereas most schools from medium-HDI countries offered a 5-year medical curriculum. A formal teaching program was available in only 42% of these schools in contrast to 94% of medical schools from very high-HDI. Overall, 25% of all medical schools did not offer structured TM teaching. When offered, most TM teaching was mandatory (95%) and integrated within the third and fourth year of medical school. Formal assessment of TM knowledge was done in 72% of all responding medical schools. More than half of the deans considered the TM education in their medical schools as inadequate. CONCLUSION Despite its limitations, the current survey highlights significant gaps and opportunities of TM education at a global scale.
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Affiliation(s)
- Arwa Z Al-Riyami
- Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Vernon J Louw
- Division of Clinical Haematology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Alexander J Indrikovs
- Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Elena Nedelcu
- Division of Transfusion Medicine, Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Sara Bakhtary
- Division of Transfusion Medicine, Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Quentin G Eichbaum
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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18
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Management of Nonpregnant Women Presenting to the Emergency Department With Iron Deficiency Anemia Caused by Uterine Blood Loss: A Retrospective Cohort Study. J Emerg Med 2020; 59:348-356. [DOI: 10.1016/j.jemermed.2020.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/28/2020] [Accepted: 05/04/2020] [Indexed: 02/07/2023]
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19
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Rigal JC, Riche VP, Tching-Sin M, Fronteau C, Huon JF, Cadiet J, Boukhari R, Vourc'h M, Rozec B. Cost of red blood cell transfusion; evaluation in a French academic hospital. Transfus Clin Biol 2020; 27:222-228. [PMID: 32810606 DOI: 10.1016/j.tracli.2020.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The economic impact of Patient blood management (PBM) must be assessed beyond the acquisition cost of blood products alone. The estimate of indirect costs may vary depending on the organization and the elements taken into account. The transposition of data from the literature into a specific local context is therefore delicate. The objective of this work was to evaluate the overall cost of red blood cell concentrate (RBC) transfusion from a French healthcare establishment point of view. METHODS We carried out an activity based costing analysis in our hospital for the year 2018. The steps of the transfusion process and additional costs were detailed and cumulated (resource consumption, labor time, frequency) to populate the ABC model. Several scenarios were developed focusing either on RBC, all blood products or the surgical activity, and a univariate sensitivity analysis was conducted. RESULTS The average total cost of transfusion, including acquisition cost, was 339,64 euros per RBC transfused. The cost of administration was 138.41 euros/RBC. Focusing only on surgical activities increased this cost (152.43 euros) while taking all blood products into account reduced it (92.49 euros). CONCLUSION The difference in our results with the literature confirms the local variability in the cost of transfusion, which may affect the economic impact of PBM. Our study related to the specific context of a single French institution has limitations that a multicenter study would clarify in order to carry out economic modelling of transfusion optimization and alternatives and to guide the choice of PBM strategies at the national level.
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Affiliation(s)
- J-C Rigal
- Service d'anesthésie et de réanimation chirurgicale, hôpital Guillaume-et-René-Laënnec, CHU de Nantes, 5, allée de l'Île Gloriette, 44093 Nantes cedex 1, France.
| | - V P Riche
- Département recherche clinique partenariat et innovation, centre hospitalier universitaire de Nantes, 5, allée de l'Île Gloriette, 44093 Nantes cedex 1, France.
| | - M Tching-Sin
- Pharmacie centrale, centre hospitalier universitaire de Nantes, 5, allée de l'Île Gloriette, 44093 Nantes cedex 1, France.
| | - C Fronteau
- Pharmacie centrale, centre hospitalier universitaire de Nantes, 5, allée de l'Île Gloriette, 44093 Nantes cedex 1, France.
| | - J-F Huon
- Pharmacie centrale, centre hospitalier universitaire de Nantes, 5, allée de l'Île Gloriette, 44093 Nantes cedex 1, France.
| | - J Cadiet
- Service d'anesthésie et de réanimation chirurgicale, hôpital Guillaume-et-René-Laënnec, CHU de Nantes, 5, allée de l'Île Gloriette, 44093 Nantes cedex 1, France.
| | - R Boukhari
- Unité de sécurité transfusionnelle et d'hémovigilance, centre hospitalier universitaire de Nantes, 5, allée de l'Île Gloriette, 44093 Nantes cedex 1, France.
| | - M Vourc'h
- Service d'anesthésie et de réanimation chirurgicale, hôpital Guillaume-et-René-Laënnec, CHU de Nantes, 5, allée de l'Île Gloriette, 44093 Nantes cedex 1, France.
| | - B Rozec
- Service d'anesthésie et de réanimation chirurgicale, hôpital Guillaume-et-René-Laënnec, CHU de Nantes, 5, allée de l'Île Gloriette, 44093 Nantes cedex 1, France; CNRS, Inserm, l'institut du thorax, université de Nantes, CHU de Nantes, 5, allée de l'Île Gloriette, 44093 Nantes cedex 1, France.
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20
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Rigal JC. WITHDRAWN: Évaluation du coût de la transfusion de concentrés de globules rouges dans un établissement de soins français. Transfus Clin Biol 2020:S1246-7820(20)30080-X. [PMID: 32593713 DOI: 10.1016/j.tracli.2020.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/14/2020] [Accepted: 06/18/2020] [Indexed: 10/24/2022]
Affiliation(s)
- J-C Rigal
- Service d'anesthésie et de réanimation chirurgicale, hôpital Guillaume-et-René-Laënnec, centre hospitalier universitaire de Nantes, 5, allée de l'Île-Gloriette, 44093 Nantes cedex 1, France
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21
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Foster M, Presseau J, McCleary N, Carroll K, McIntyre L, Hutton B, Brehaut J. Audit and feedback to improve laboratory test and transfusion ordering in critical care: a systematic review. Implement Sci 2020; 15:46. [PMID: 32560666 PMCID: PMC7303577 DOI: 10.1186/s13012-020-00981-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 03/12/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Laboratory tests and transfusions are sometimes ordered inappropriately, particularly in the critical care setting, which sees frequent use of both. Audit and Feedback (A&F) is a potentially useful intervention for modifying healthcare provider behaviors, but its application to the complex, team-based environment of critical care is not well understood. We conducted a systematic review of the literature on A&F interventions for improving test or transfusion ordering in the critical care setting. METHODS Five databases, two registries, and the bibliographies of relevant articles were searched. We included critical care studies that assessed the use of A&F targeting healthcare provider behaviors, alone or in combination with other interventions to improve test and transfusion ordering, as compared to historical practice, no intervention, or another healthcare behaviour change intervention. Studies were included only if they reported laboratory test or transfusion orders, or the appropriateness of orders, as outcomes. There were no restrictions based on study design, date of publication, or follow-up time. Intervention characteristics and absolute differences in outcomes were summarized. The quality of individual studies was assessed using a modified version of the Effective Practice and Organisation of Care Cochrane Review Group's criteria. RESULTS We identified 16 studies, including 13 uncontrolled before-after studies, one randomized controlled trial, one controlled before-after study, and one controlled clinical trial (quasi-experimental). These studies described 17 interventions, mostly (88%) multifaceted interventions with an A&F component. Feedback was most often provided in a written format only (41%), more than once (53%), and most often only provided data aggregated to the group-level (41%). Most studies saw a change in the hypothesized direction, but not all studies provided statistical analyses to formally test improvement. Overall study quality was low, with studies often lacking a concurrent control group. CONCLUSIONS Our review summarizes characteristics of A&F interventions implemented in the critical care context, points to some mechanisms by which A&F might be made more effective in this setting, and provides an overview of how the appropriateness of orders was reported. Our findings suggest that A&F can be effective in the context of critical care; however, further research is required to characterize approaches that optimize the effectiveness in this setting alongside more rigorous evaluation methods. TRIAL REGISTRATION PROSPERO CRD42016051941.
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Affiliation(s)
- Madison Foster
- School of Epidemiology and Public Health, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, General Campus, 501 Smyth Road, Centre for Practice Changing Research, Box 201B, Ottawa, ON K1H 8L6 Canada
| | - Justin Presseau
- School of Epidemiology and Public Health, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, General Campus, 501 Smyth Road, Centre for Practice Changing Research, Box 201B, Ottawa, ON K1H 8L6 Canada
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Vanier Hall, Ottawa, ON K1N 6N5 Canada
| | - Nicola McCleary
- School of Epidemiology and Public Health, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, General Campus, 501 Smyth Road, Centre for Practice Changing Research, Box 201B, Ottawa, ON K1H 8L6 Canada
| | - Kelly Carroll
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, General Campus, 501 Smyth Road, Centre for Practice Changing Research, Box 201B, Ottawa, ON K1H 8L6 Canada
| | - Lauralyn McIntyre
- School of Epidemiology and Public Health, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, General Campus, 501 Smyth Road, Centre for Practice Changing Research, Box 201B, Ottawa, ON K1H 8L6 Canada
- Department of Critical Care Medicine, The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - Brian Hutton
- School of Epidemiology and Public Health, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, General Campus, 501 Smyth Road, Centre for Practice Changing Research, Box 201B, Ottawa, ON K1H 8L6 Canada
- Ottawa Hospital Research Institute, Knowledge Synthesis Unit, The Ottawa Hospital, General Campus, 501 Smyth Road, Centre for Practice Changing Research, Box 201B, Ottawa, ON K1H 8L6 Canada
| | - Jamie Brehaut
- School of Epidemiology and Public Health, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, General Campus, 501 Smyth Road, Centre for Practice Changing Research, Box 201B, Ottawa, ON K1H 8L6 Canada
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22
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Lu L, Che J, Xie W, Cheng W, Yang Z, Dong R, Huang J, Lu J. Adjusted preoperative variables to predict perioperative red blood cell transfusion in coronary artery bypass grafting. Gen Thorac Cardiovasc Surg 2020; 68:1377-1387. [PMID: 32418192 DOI: 10.1007/s11748-020-01386-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/01/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The variables for predicting blood transfusion perioperatively are not completely clear in coronary artery bypass grafting (CABG) patients. OBJECTIVES To construct a comprehensive model to predict perioperative RBC transfusion in patients undergoing isolated CABG using adjusted preoperative variables. METHODS Perioperative data of 1253 patients who underwent isolated CABG by the same surgical team were collected from April 2018 to March 2019. Logistic regression analyses were used to establish equations to construct two models for predicting intraoperative and postoperative RBC transfusions, respectively. All significant variables included in the two models were combined to form a comprehensive model to predict perioperative RBC transfusion. Area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the discriminatory power of the models. RESULTS The total RBC transfusion rate for CABG patients during hospitalization was 29.05%. The rate of intraoperative and postoperative RBC transfusions was 6.9% and 26.7%, respectively. Eight variables in a total of 30 risk factors constituted the intraoperative prediction model, 12 variables constituted the postoperative prediction model, and 13 variables for the combined model. The AUC of the three models were 0.87, 0.82, and 0.83, respectively, demonstrating moderate discriminatory power for RBC transfusion during the intraoperative, postoperative, and perioperative periods. CONCLUSION The comprehensive model combined with all variables of predicting intraoperative and postoperative RBC transfusion is feasible for predicting perioperative RBC transfusion.
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Affiliation(s)
- Liangyuan Lu
- Department of Anesthesiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, 2 An Zhen Road, Chaoyang District, Beijing, 100029, Beijing, China
- Department of Anesthesiology, Aerospace Center Hospital, Beijing, China
| | - Ji Che
- Department of Transfusion, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Wuxiang Xie
- Peking University Clinical Research Institute, Peking University Health Science Center, Beijing, China
| | - Weiping Cheng
- Department of Anesthesiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, 2 An Zhen Road, Chaoyang District, Beijing, 100029, Beijing, China
| | - Zhanmin Yang
- Department of Anesthesiology, Aerospace Center Hospital, Beijing, China
| | - Ran Dong
- Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jiapeng Huang
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, 530 South Jackson Street, Louisville, KY, 40202, USA.
| | - Jiakai Lu
- Department of Anesthesiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, 2 An Zhen Road, Chaoyang District, Beijing, 100029, Beijing, China.
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23
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Jung-König M, Füllenbach C, Murphy MF, Manzini P, Laspina S, Pendry K, Mühling J, Wikman A, Humbrecht C, Rigal JC, Lasocki S, Folléa G, Seifried E, Müller MM, Geisen C, Aranko K, Zacharowski K, Meybohm P. Programmes for the management of preoperative anaemia: audit in ten European hospitals within the PaBloE (Patient Blood Management in Europe) Working Group. Vox Sang 2019; 115:182-191. [PMID: 31877577 DOI: 10.1111/vox.12872] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/06/2019] [Accepted: 11/11/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Preoperative anaemia is an independent risk factor for a higher morbidity and mortality, a longer hospitalization and increased perioperative transfusion rates. Managing preoperative anaemia is the first of three pillars of Patient Blood Management (PBM), a multidisciplinary concept to improve patient safety. While various studies provide medical information on (successful) anaemia treatment pathways, knowledge of organizational details of diagnosis and management of preoperative anaemia across Europe is scarce. MATERIALS AND METHODS To gain information on various aspects of preoperative anaemia management including organization, financing, diagnostics and treatment, we conducted a survey (74 questions) in ten hospitals from seven European nations within the PaBloE (Patient Blood Management in Europe) working group covering the year 2016. RESULTS Organization and activity in the field of preoperative anaemia management were heterogeneous in the participating hospitals. Almost all hospitals had pathways for managing preoperative anaemia in place, however, only two nations had national guidelines. In six of the ten participating hospitals, preoperative anaemia management was organized by anaesthetists. Diagnostics and treatment focused on iron deficiency anaemia which, in most hospitals, was corrected with intravenous iron. CONCLUSION Implementation and approaches of preoperative anaemia management vary across Europe with a primary focus on treating iron deficiency anaemia. Findings of this survey motivated the hospitals involved to critically evaluate their practice and may also help other hospitals interested in PBM to develop action plans for diagnosis and management of preoperative anaemia.
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Affiliation(s)
- Mona Jung-König
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Christoph Füllenbach
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Michael F Murphy
- NHS Blood & Transplant, Oxford University Hospitals NHS Foundation Trust, National Institute of Health Research Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Paola Manzini
- Banca del Sangue e del Plasma, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Stefan Laspina
- Hospital Blood Bank, Mater Dei University Hospital, Msida, Malta
| | - Kate Pendry
- Department of Transfusion, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Jörg Mühling
- Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Agneta Wikman
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Sigismond Lasocki
- Département Anesthésie Réanimation, CHU Angers, LUNAM Université d'Angers, Angers, France
| | - Gilles Folléa
- Société Française de Transfusion Sanguine, Paris, France
| | - Erhard Seifried
- German Red Cross, Institute for Transfusion Medicine and Immunohematology, German Red Cross Baden-Wuertemberg - Hessen, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Markus M Müller
- German Red Cross, Institute for Transfusion Medicine and Immunohematology, German Red Cross Baden-Wuertemberg - Hessen, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Christof Geisen
- German Red Cross, Institute for Transfusion Medicine and Immunohematology, German Red Cross Baden-Wuertemberg - Hessen, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Kari Aranko
- European Blood Alliance, Amsterdam, The Netherlands
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.,Department of Anesthesiology, University Hospital Wuerzburg, Wuerzburg, Germany
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24
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Ning S, Zeller MP. Management of iron deficiency. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:315-322. [PMID: 31808874 PMCID: PMC6913441 DOI: 10.1182/hematology.2019000034] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Iron deficiency (ID) affects billions of people worldwide and remains the leading cause of anemia with significant negative impacts on health. Our approach to ID and iron deficiency anemia (IDA) involves three steps (I3): (1) identification of ID/IDA, (2) investigation of and management of the underlying etiology of ID, and (3) iron repletion. Iron repletion options include oral and intravenous (IV) iron formulations. Oral iron remains a therapeutic option for the treatment of ID in stable patients, but there are many populations for whom IV iron is more effective. Therefore, IV iron should be considered when there are no contraindications, when poor response to oral iron is anticipated, when rapid hematologic responses are desired, and/or when there is availability of and accessibility to the product. Judicious use of red cell blood transfusion is recommended and should be considered only for severe, symptomatic IDA with hemodynamic instability. Identification and management of ID and IDA is a central pillar in patient blood management.
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Affiliation(s)
- Shuoyan Ning
- Division of Hematology and Thromboembolism and
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada; and
| | - Michelle P Zeller
- Division of Hematology and Thromboembolism and
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada; and
- Canadian Blood Services, Ancaster, ON, Canada
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25
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Nielsen P. [Not Available]. MMW Fortschr Med 2019; 161:26-28. [PMID: 31414453 DOI: 10.1007/s15006-019-0761-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Peter Nielsen
- Institut für Biochemie und Molekulare Zellbiologie (IBMZ), Interdisziplinäre Arbeitsgruppe, Eisenstoffwechsel, Martinistr. 52, D-20246, Hamburg, Deutschland.
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26
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Bruun MT, Yazer MH, Spinella PC, Titlestad K, Lozano M, Delaney M, Lejdarová H, Pavlova DE, Trakhtman P, Starostin N, Zhiburt E, van Kraaij MGJ, Huisman E, Kutner JM, Sakashita AM, Yokoyama APH, Zubicaray J, Sevilla J, Okazaki H, Hiwatari M, Nagura Y, Manzini PM, Facco G, Avdis C, Singh L, Hans R, Sharma RR, Kumar P, Wikman A, Deschmann E, Kaur H, Mei JLC, Ying SHK, Pei Lin K, New HV, Moss R, Kinmonth A, Comande M, Savoia H, Crighton G, Yacobovich J, Yahalom V, Lau W. Vox Sanguinis International Forum on paediatric indications for blood component transfusion: Summary. Vox Sang 2019; 114:523-530. [PMID: 31087379 DOI: 10.1111/vox.12763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Mie Topholm Bruun
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Mark H Yazer
- The Institute for Transfusion Medicine, Pittsburgh, PA, USA
| | - Philip C Spinella
- Department of Pediatrics, Division of Critical Care Medicine, Washington University in St Louis, St Louis, MO, USA
| | - Kjell Titlestad
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Miquel Lozano
- Department of Hemotherapy and Hemostasis, Hospital Clinic, Barcelona, Spain
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27
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Affiliation(s)
- Michelle P Zeller
- McMaster University, Hamilton, Ontario, Canada
- Canadian Blood Services, Hamilton, Ontario, Canada
| | - Richard M Kaufman
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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28
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Bullock T, Hazell M, McCullagh J. Advances in Transfusion Medicine RCPath, November 2018. Transfus Med 2019; 29:4-15. [DOI: 10.1111/tme.12590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 02/07/2019] [Accepted: 02/11/2019] [Indexed: 11/27/2022]
Affiliation(s)
| | - M. Hazell
- NHS Blood and Transplant; Bristol UK
| | - J. McCullagh
- Whipps Cross University Hospital; Barts Health NHS Trust; London UK
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29
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Siotou K, Siotos C, Azizi A, Cheah MA, Seal SM, Redett RJ, Rosson GD. The Role of Antifibrinolytics in Reducing Blood Loss During Craniofacial or Orthognathic Surgical Procedures: A Meta-Analysis. J Oral Maxillofac Surg 2019; 77:1245-1260. [PMID: 30796910 DOI: 10.1016/j.joms.2019.01.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/19/2019] [Accepted: 01/21/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Use of antifibrinolytic drugs in craniofacial and orthognathic surgery seems quite promising and has strong advocates. However, supporting evidence is controversial and limited by a small sample of individual studies. We sought to systematically review and meta-analyze the available data regarding the role of preoperative or intraoperative antifibrinolytic drugs (eg, tranexamic acid, aprotinin, or aminocaproic acid) in craniofacial and orthognathic surgery. MATERIALS AND METHODS We searched PubMed, Scopus, Embase, the Cochrane Library, and Web of Science through April 19, 2018, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Outcomes of interest included the volume of blood loss, volume of transfusions, and operative time. A meta-analysis was performed with a random-effects model using Review Manager (RevMan) software (The Cochrane Collaboration, Copenhagen, Denmark). RESULTS We identified 32 eligible studies with 749 patients undergoing craniofacial surgery and 546 undergoing orthognathic surgery. Meta-analysis showed that antifibrinolytic use led to statistically significant decreases in blood loss and blood transfusions for craniofacial procedures in adult or pediatric patients and to significantly less blood loss during orthognathic surgical procedures. Operative time did not significantly differ for either type of surgery. CONCLUSIONS Antifibrinolytics can significantly reduce blood loss in craniofacial surgical procedures including pediatric craniosynostosis and adult rhinoplasties and in orthognathic surgical procedures, as well as transfusion requirements in pediatric craniofacial surgical procedures. However, the clinical significance of the medications is still questionable because of the relative paucity of information on adverse effects and the usual small volume loss during those operations.
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Affiliation(s)
- Kalliopi Siotou
- Research Fellow, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalampos Siotos
- Research Fellow, Department of Plastic & Reconstructive Surgery, Johns Hopkins University, Baltimore, MD.
| | - Armina Azizi
- Research Fellow, Department of Plastic & Reconstructive Surgery, Johns Hopkins University, Baltimore, MD
| | - Michael A Cheah
- Research Fellow, Department of Plastic & Reconstructive Surgery, Johns Hopkins University, Baltimore, MD; and Resident, Inova Fairfax Medical Campus, Falls Church, VA
| | - Stella M Seal
- Associate Director, Welch Medical Library, Johns Hopkins University, Baltimore, MD
| | - Richard J Redett
- Professor, Department of Plastic & Reconstructive Surgery, Johns Hopkins University, Baltimore, MD
| | - Gedge D Rosson
- Associate Professor, Department of Plastic & Reconstructive Surgery, Johns Hopkins University, Baltimore, MD
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30
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Ripollés-Melchor J, García-Erce JA, Vincent JL. Transfusion thresholds and red blood cells transfusion focused on tissue oxygenation. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2018; 65:363-365. [PMID: 29657065 DOI: 10.1016/j.redar.2018.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 03/13/2018] [Accepted: 03/15/2018] [Indexed: 06/08/2023]
Affiliation(s)
- J Ripollés-Melchor
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España.
| | - J A García-Erce
- Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España; Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, España; Grupo de Trabajo de la Sociedad Española de Transfusión Sanguínea «Hemoterapia basada en sentido común», España; Grupo Multidisciplinar para el Estudio y Manejo de la Anemia del Paciente Quirúrgico (www.awge.org), España; Grupo idiPAZ de «Investigación en PBM», Madrid, España
| | - J-L Vincent
- Department of Intensive Care, Erasme University Hospital (Université Libre de Bruxelles), Bruselas, Bélgica
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31
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Tsang HC, Garcia A, Scott R, Lancaster D, Geary D, Nguyen AT, Shankar R, Buchanan L, Pham TD. Streamlining a blood center and hospital transfusion service supply chain with an informatics vendor-managed inventory solution: development, implementation, and 3-month follow-up. Transfusion 2018; 58:1718-1725. [PMID: 29770454 DOI: 10.1111/trf.14766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/15/2018] [Accepted: 02/15/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND The ordering process at Stanford Health Care involved twice-daily shipments predicated upon current stock levels from the blood center to the hospital transfusion service. Manual census determination is time consuming and error prone. We aimed to enhance inventory management by developing an informatics platform to streamline the ordering process and reallocate staff productivity. STUDY DESIGN AND METHODS The general inventory accounts for more than 50 product categories based on characteristics including component, blood type, irradiation status, and cytomegalovirus serology status. Over a 5-month calibration period, inventory levels were determined algorithmically and electronically. An in-house software program was created to determine inventory levels, optimize the electronic ordering process, and reduce labor time. A 3-month pilot period was implemented using this program. RESULTS This system showed noninferiority while saving labor time. The average weekly transfused:stocked ratios for cryoprecipitate, plasma, and red blood cells, respectively, were 1.03, 1.21, and 1.48 before the pilot period, compared with 0.88, 1.17, and 1.40 during (p = 0.28). There were 27 (before) and 31 (during) average STAT units ordered per week (p = 0.86). The number of monthly wasted products due to expiration was 226 (before) and 196 (during) units, respectively (p = 0.28). An estimated 7 hours per week of technologist time was reallocated to other tasks. CONCLUSION An in-house electronic ordering system can enhance information fidelity, reallocate and optimize valuable staff productivity, and further standardize ordering. This system showed noninferiority to the labor-intensive manual system while freeing up over 360 hours of staff time per year.
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Affiliation(s)
- Hamilton C Tsang
- Department of Laboratory Medicine, University of Washington, Seattle, Washington.,Stanford Hospital Transfusion Service, Stanford, California
| | - Adam Garcia
- Stanford Blood Center, Stanford Health Care, Stanford Medicine, Stanford, California
| | - Robert Scott
- Stanford Hospital Transfusion Service, Stanford, California
| | - David Lancaster
- Stanford Blood Center, Stanford Health Care, Stanford Medicine, Stanford, California
| | - Dianne Geary
- Stanford Blood Center, Stanford Health Care, Stanford Medicine, Stanford, California
| | - Anh-Thu Nguyen
- Stanford Hospital Transfusion Service, Stanford, California
| | - Raina Shankar
- Stanford Hospital Transfusion Service, Stanford, California
| | | | - Tho D Pham
- Stanford Hospital Transfusion Service, Stanford, California.,Stanford Blood Center, Stanford Health Care, Stanford Medicine, Stanford, California.,Department of Pathology, Stanford University School of Medicine, Stanford, California
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32
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Voorn VMA, van Bodegom-Vos L, So-Osman C. Towards a systematic approach for (de)implementation of patient blood management strategies. Transfus Med 2018; 28:158-167. [PMID: 29508467 DOI: 10.1111/tme.12520] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/26/2018] [Accepted: 02/12/2018] [Indexed: 12/14/2022]
Abstract
Despite the increasing availability of evidence in transfusion medicine literature, this evidence does not automatically find its way into practice. This is also applicable to patient blood management (PBM). It may concern the lack of implementation of effective new techniques or treatments, or it may apply to the (over)use of techniques and treatments (e.g. inappropriate transfusions) that have proven to be of limited benefit for patients (low-value care) and could be abandoned (de-implementation). In PBM literature, the implementation of restrictive transfusion thresholds and the de-implementation of inappropriate transfusions are described. However, most implementation strategies were not preceded by the identification of relevant barriers, and the used strategies were not often supported by literature on behavioural changes. In this article, we describe implementation vs de-implementation, highlight the current situation of (de)implementation in PBM and describe a systematic approach for (de)implementation illustrated by an example of a PBM de-implementation study regarding '(cost-) effective patient blood management in total hip and knee arthroplasty'. The systematic approach used for (de)implementation is based on the implementation model of Grol, which consists of the following five steps: the detection of improvement goals, a problem analysis, the selection of (de)implementation strategies, the execution of the (de)implementation strategy and an evaluation. Based on the description of the current situation and the experiences in our de-implementation study, we can conclude that de-implementation may be more difficult than expected as other factors may play a role in effective de-implementation compared to implementation.
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Affiliation(s)
- V M A Voorn
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.,Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - L van Bodegom-Vos
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - C So-Osman
- Unit Transfusion Medicine, Sanquin, Leiden, The Netherlands.,Department of Internal Medicine, Groene Hart Hospital, Gouda, The Netherlands
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33
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Blaudszun G, Munting KE, Butchart A, Gerrard C, Klein AA. The association between borderline pre-operative anaemia in women and outcomes after cardiac surgery: a cohort study. Anaesthesia 2018; 73:572-578. [DOI: 10.1111/anae.14185] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2017] [Indexed: 12/15/2022]
Affiliation(s)
- G. Blaudszun
- Department of Anaesthesia and Intensive Care; Papworth Hospital; Cambridge UK
| | - K. E. Munting
- Department of Anaesthesia and Intensive Care; Papworth Hospital; Cambridge UK
| | - A. Butchart
- Department of Anaesthesia and Intensive Care; Papworth Hospital; Cambridge UK
| | - C. Gerrard
- Department of Anaesthesia and Intensive Care; Papworth Hospital; Cambridge UK
| | - A. A. Klein
- Department of Anaesthesia and Intensive Care; Papworth Hospital; Cambridge UK
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34
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Martin AK, Renew JR, Ramakrishna H. Restrictive Versus Liberal Transfusion Strategies in Perioperative Blood Management: An Evidence-Based Analysis. J Cardiothorac Vasc Anesth 2017; 31:2304-2311. [DOI: 10.1053/j.jvca.2017.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Indexed: 01/28/2023]
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35
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Manzini PM, Dall'Omo AM, D'Antico S, Valfrè A, Pendry K, Wikman A, Fischer D, Borg-Aquilina D, Laspina S, van Pampus ECM, van Kraaij M, Bruun MT, Georgsen J, Grant-Casey J, Babra PS, Murphy MF, Folléa G, Aranko K. Patient blood management knowledge and practice among clinicians from seven European university hospitals: a multicentre survey. Vox Sang 2017; 113:60-71. [DOI: 10.1111/vox.12599] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 09/12/2017] [Accepted: 09/12/2017] [Indexed: 01/28/2023]
Affiliation(s)
- P. M. Manzini
- Banca del Sangue e del Plasma; Città della Salute e della Scienza di Torino; Torino Italy
| | - A. M. Dall'Omo
- Banca del Sangue e del Plasma; Città della Salute e della Scienza di Torino; Torino Italy
| | - S. D'Antico
- Banca del Sangue e del Plasma; Città della Salute e della Scienza di Torino; Torino Italy
| | - A. Valfrè
- Banca del Sangue e del Plasma; Città della Salute e della Scienza di Torino; Torino Italy
| | - K. Pendry
- Department of Transfusion; Central Manchester University Hospitals NHS Foundation Trust; Manchester UK
| | - A. Wikman
- Department of Clinical Immunology and Transfusion Medicine; Karolinska University Hospital; Stockholm Sweden
| | - D. Fischer
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy; University Hospital Frankfurt; Frankfurt Germany
| | - D. Borg-Aquilina
- Hospital Blood Bank; Mater Dei University Hospital; Msida Malta
| | - S. Laspina
- Hospital Blood Bank; Mater Dei University Hospital; Msida Malta
| | - E. C. M. van Pampus
- Laboratory of Medical Immunology; Radboud University Medical Center; Nijmegen The Netherlands
| | - M. van Kraaij
- Laboratory of Medical Immunology; Radboud University Medical Center; Nijmegen The Netherlands
- Department of Transfusion Medicine and Donor Affairs; Sanquin Blood bank; Amsterdam The Netherlands
| | - M. T. Bruun
- Department of Clinical Immunology; Odense University Hospital; Odense Denmark
| | - J. Georgsen
- Department of Clinical Immunology; Odense University Hospital; Odense Denmark
| | | | - P. S. Babra
- Oxford Blood Centre; NHS Blood & Transplant; Oxford UK
| | - M. F. Murphy
- Oxford Blood Centre; NHS Blood & Transplant; Oxford UK
| | - G. Folléa
- French Blood Establishment; Saint Denis France
| | - K. Aranko
- European Blood Alliance; Amsterdam The Netherlands
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36
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Napolitano LM. Anemia and Red Blood Cell Transfusion: Advances in Critical Care. Crit Care Clin 2017; 33:345-364. [PMID: 28284299 DOI: 10.1016/j.ccc.2016.12.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Anemia is common in the intensive care unit (ICU), resulting in frequent administration of red blood cell (RBC) transfusions. Significant advances have been made in understanding the pathophysiology of anemia in the ICU, which is anemia of inflammation. This anemia is related to high hepcidin concentrations resulting in iron-restricted erythropoiesis, and decreased erythropoietin concentrations. A new hormone (erythroferrone) has been identified, which mediates hepcidin suppression to allow increased iron absorption and mobilization from iron stores. RBC transfusions are most commonly administered to ICU patients for treatment of anemia. All strategies to reduce anemia in the ICU should be implemented.
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Affiliation(s)
- Lena M Napolitano
- Division of Acute Care Surgery [Trauma, Burns, Critical Care, Emergency Surgery], Department of Surgery, University of Michigan Health System, University Hospital, Room 1C340-UH, 1500 East Medical Drive, SPC 5033, Ann Arbor, MI 48109-5033, USA.
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37
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Bruun MT, Georgsen J, Titlestad K, Yazer M, Murphy MF. Patient Blood Management - from local initiatives to European collaborations. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/voxs.12369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- M. T. Bruun
- Department of Clinical Immunology; Odense University Hospital; Odense C Denmark
- Member of PaBloE; Working Group of the European Blood Alliance
| | - J. Georgsen
- Department of Clinical Immunology; Odense University Hospital; Odense C Denmark
- Member of PaBloE; Working Group of the European Blood Alliance
| | - K. Titlestad
- Department of Clinical Immunology; Odense University Hospital; Odense C Denmark
| | - M. Yazer
- Department of Clinical Immunology; Odense University Hospital; Odense C Denmark
- University of Pittsburgh; Pittsburgh PA USA
| | - M. F. Murphy
- Member of PaBloE; Working Group of the European Blood Alliance
- NHS Blood & Transplant; Oxford UK
- Oxford University Hospitals NHS Foundation Trust; Oxford UK
- University of Oxford; Oxford UK
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38
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Lassale B, Daurat G, Besse-Moreau M, Aullen JP. L’hémovigilance française de 1994 à nos jours : évolution et perspectives. Transfus Clin Biol 2017. [DOI: 10.1016/j.tracli.2017.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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39
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Strengers PF, Klein HG. Plasma is a strategic resource. Transfusion 2016; 56:3133-3137. [DOI: 10.1111/trf.13913] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 09/19/2016] [Accepted: 09/21/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Paul F.W. Strengers
- Sanquin Plasma Products; Amsterdam the Netherlands
- International Plasma Fractionation Association, The Netherlands; Amsterdam The Netherlands
| | - Harvey G. Klein
- Department of Transfusion Medicine, Clinical Center; National Institutes of Health; Bethesda Maryland
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40
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Folléa G. Gestion du sang du patient et pour le patient. Transfus Clin Biol 2016; 23:175-184. [DOI: 10.1016/j.tracli.2016.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 08/22/2016] [Indexed: 12/28/2022]
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Shander A, Bracey AW, Goodnough LT, Gross I, Hassan NE, Ozawa S, Marques MB. Patient Blood Management as Standard of Care. Anesth Analg 2016; 123:1051-3. [DOI: 10.1213/ane.0000000000001496] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Bruun MT, Pendry K, Georgsen J, Manzini P, Lorenzi M, Wikman A, Borg-Aquilina D, van Pampus E, van Kraaij M, Fischer D, Meybohm P, Zacharowski K, Geisen C, Seifried E, Liumbruno GM, Folléa G, Grant-Casey J, Babra P, Murphy MF. Patient Blood Management in Europe: surveys on top indications for red blood cell use and Patient Blood Management organization and activities in seven European university hospitals. Vox Sang 2016; 111:391-398. [DOI: 10.1111/vox.12435] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 06/07/2016] [Accepted: 06/28/2016] [Indexed: 01/28/2023]
Affiliation(s)
- M. T. Bruun
- Department of Clinical Immunology; Odense University Hospital; Odense Denmark
| | - K. Pendry
- Department of Transfusion; Central Manchester University Hospitals NHS Foundation Trust; Manchester UK
- NHS Blood & Transplant; Manchester UK
| | - J. Georgsen
- Department of Clinical Immunology; Odense University Hospital; Odense Denmark
| | - P. Manzini
- Banca del Sangue e del Plasma CPVE; Città della Salute e della Scienza di Torino; Torino Italy
| | - M. Lorenzi
- Banca del Sangue e del Plasma CPVE; Città della Salute e della Scienza di Torino; Torino Italy
| | - A. Wikman
- Department of Clinical Immunology and Transfusion Medicine; Karolinska University Hospital; Stockholm Sweden
| | | | - E. van Pampus
- Laboratory of Medical Immunology; Radboud University Medical Centre; Nijmegen The Netherlands
| | - M. van Kraaij
- Department of Transfusion Medicine; Sanquin Blood Bank; Amsterdam The Netherlands
| | - D. Fischer
- Department of Anaesthesiology; Intensive Care Medicine and Pain Therapy; University Hospital Frankfurt; Frankfurt Germany
| | - P. Meybohm
- Department of Anaesthesiology; Intensive Care Medicine and Pain Therapy; University Hospital Frankfurt; Frankfurt Germany
| | - K. Zacharowski
- Department of Anaesthesiology; Intensive Care Medicine and Pain Therapy; University Hospital Frankfurt; Frankfurt Germany
| | - C. Geisen
- German Red Cross Blood Service Baden-Wuerttemberg-Hessen; Institute of Transfusion Medicine and Immunohaematology; Frankfurt Germany
| | - E. Seifried
- German Red Cross Blood Service Baden-Wuerttemberg-Hessen; Institute of Transfusion Medicine and Immunohaematology; Frankfurt Germany
| | - G. M. Liumbruno
- Italian National Blood Centre; National Institute of Health; Rome Italy
| | - G. Folléa
- European Blood Alliance; Amsterdam The Netherlands
| | | | - P. Babra
- NHS Blood & Transplant; Manchester UK
| | - M. F. Murphy
- NHS Blood & Transplant; Manchester UK
- Oxford University Hospitals NHS Foundation Trust; Oxford UK
- University of Oxford; Oxford UK
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43
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Folléa G. Rethinking blood components and patients: Patient blood management. Possible ways for development in France. Presse Med 2016; 45:e273-80. [DOI: 10.1016/j.lpm.2016.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Desborough MJR, Hockley B, Sekhar M, Burroughs AK, Stanworth SJ, Jairath V. Patterns of blood component use in cirrhosis: a nationwide study. Liver Int 2016; 36:522-9. [PMID: 26537012 DOI: 10.1111/liv.12999] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 10/27/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Cirrhosis is a complex acquired disorder of coagulation and frequent indication for transfusion of blood components. We characterised blood component use in patients with cirrhosis and compared this to transfusion guidelines. METHODS All National Health Service trusts with representation on the British Society of Gastroenterology membership list were invited to take part. Data were collected prospectively on consecutive, unselected, hospitalised admissions with cirrhosis over 28 days. Detailed information was recorded for patients receiving blood components including indication (for bleeding or prophylaxis), type of component, laboratory indices triggering transfusion, complications, thromboembolic events and clinical outcome to day 28. RESULTS Data on 1313 consecutive patients with cirrhosis were collected from 85 hospitals. A total of 391/1313 (30%) were transfused a blood component; in 238/391 (61%), this was for treatment of bleeding and in 153/391 (39%) for prophylaxis of bleeding. In 48/185 (26%) cases with bleeding, the haemoglobin threshold was >80 g/L prior to red blood cell transfusion. In the prophylaxis group, 238/391 (61%) received transfusion in response to an abnormal haematological value in the absence of any planned procedure. In patients transfused for procedural prophylaxis, 10/34 (29%) received fresh frozen plasma at an International Normalised Ratio lower than the threshold where a benefit would be anticipated. An in-patient thromboembolic event was recorded in 3% (35/1313) and 10% (138/1313) died by day 28. CONCLUSIONS One-third of hospitalised patients with cirrhosis were transfused. Strategies for Patient Blood Management should include ensuring transfusion practice is consistent with guidelines and greater emphasis on alternatives to transfusion.
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Affiliation(s)
- Michael J R Desborough
- NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK.,Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Brian Hockley
- NHS Blood and Transplant, Sheffield Blood Centre, Sheffield, UK
| | - Mallika Sekhar
- Department of Haematology, Royal Free Hospital, London, UK
| | - Andrew K Burroughs
- Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK.,University College London Institute of Liver and Digestive Health, University College London, London, UK
| | | | - Vipul Jairath
- NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK.,Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, UK.,Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
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Verdecchia NM, Wisniewski MK, Waters JH, Triulzi DJ, Alarcon LH, Yazer MH. Changes in blood product utilization in a seven-hospital system after the implementation of a patient blood management program: A 9-year follow-up. Hematology 2016; 21:490-9. [DOI: 10.1080/10245332.2015.1112496] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
| | - Mary Kay Wisniewski
- The Donald D. Wolff Jr Center for Quality, Safety, and Innovation at UPMC, Pittsburgh, PA, USA
| | - Jonathan H. Waters
- Department of Anesthesiology, University of Pittsburgh, PA, USA
- Department of Bioengineering and the McGowan Institute for Regenerative Medicine, University of Pittsburgh, PA, USA
| | - Darrell J. Triulzi
- Department of Pathology, University of Pittsburgh, PA, USA
- The Institute for Transfusion Medicine, Pittsburgh, PA, USA
| | - Louis H. Alarcon
- Departments of Surgery and Critical Care Medicine, University of Pittsburgh, PA, USA
| | - Mark H. Yazer
- Department of Pathology, University of Pittsburgh, PA, USA
- The Institute for Transfusion Medicine, Pittsburgh, PA, USA
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Vogt A. A commentary on “Red blood cell transfusion practice in elective liver resection: Single center scenario” by Dr Andreas Vogt. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2015. [DOI: 10.1016/j.tacc.2015.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abdel Gader AGM, AlGhumlas AK, Al Momen AKM, Badri M. A 23 years audit of packed red blood cell consumption in a university hospital in a developing country. Transfus Apher Sci 2015; 53:300-7. [PMID: 26116047 DOI: 10.1016/j.transci.2015.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 05/26/2015] [Accepted: 05/26/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND There is paucity of information on the blood transfusion practice in developing countries. The current audit aims to find out the long term trend in the consumption of packed red blood cells (PRBCs) in a large Saudi teaching hospital in Riyadh MATERIALS AND METHODS We analyzed the annual consumption of PRBCs from 1985 to 2007 in seven major hospital divisions (Medicine, General Surgery, Pediatrics, Obstetrics and Gynecology, Cardiac Surgery, Accident and Emergency and Renal Dialysis Unit) at the 850-bed King Khalid University Hospital (KKUH), Riyadh. RESULTS Grand total consumption of PRBCs was 345,642 units. The consumption increased gradually and peaked in the year 1994, dropped to 30.4% 6 years later and then increased gradually thereafter, due to the expansion in the number of patients cared for in the Departments of Medicine, Cardiac Surgery and Accident and Emergency, while in the Department of Pediatrics the drop in consumption continued unabated. In the Renal Dialysis Unit consumption was minimal with the use of erythropoietin therapy. The crossmatch:transfusion ratio uncovered gross over-ordering of PRBCs and wastage of blood bank resources in most hospital divisions most notably in the Department of Obstetrics and Gynecology. CONCLUSION The results obtained indicate clearly that there has been overuse of blood products that dropped markedly in years coinciding with the worldwide apprehension about the safety of transfusion therapy particularly HIV transmission. This factor in addition to the current implementation of strict guidelines is gradually improving transfusion practices in our institute.
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Affiliation(s)
| | - Abeer K AlGhumlas
- The Blood Bank, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Abdul Karim M Al Momen
- The Blood Bank, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Motasim Badri
- Department of Statistics, College of Sciences and Health Professions, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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