1
|
Tschoellitsch T, Moser P, Maletzky A, Seidl P, Böck C, Roland T, Ludwig H, Süssner S, Hochreiter S, Meier J. Potential Predictors for Deterioration of Renal Function After Transfusion. Anesth Analg 2024; 138:645-654. [PMID: 38364244 DOI: 10.1213/ane.0000000000006720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
BACKGROUND Transfusion of packed red blood cells (pRBCs) is still associated with risks. This study aims to determine whether renal function deterioration in the context of individual transfusions in individual patients can be predicted using machine learning. Recipient and donor characteristics linked to increased risk are identified. METHODS This study was registered at ClinicalTrials.gov (NCT05466370) and was conducted after local ethics committee approval. We evaluated 3366 transfusion episodes from a university hospital between October 31, 2016, and August 31, 2020. Random forest models were tuned and trained via Python auto-sklearn package to predict acute kidney injury (AKI). The models included recipients' and donors' demographic parameters and laboratory values, donor questionnaire results, and the age of the pRBCs. Bootstrapping on the test dataset was used to calculate the means and standard deviations of various performance metrics. RESULTS AKI as defined by a modified Kidney Disease Improving Global Outcomes (KDIGO) criterion developed after 17.4% transfusion episodes (base rate). AKI could be predicted with an area under the curve of the receiver operating characteristic (AUC-ROC) of 0.73 ± 0.02. The negative (NPV) and positive (PPV) predictive values were 0.90 ± 0.02 and 0.32 ± 0.03, respectively. Feature importance and relative risk analyses revealed that donor features were far less important than recipient features for predicting posttransfusion AKI. CONCLUSIONS Surprisingly, only the recipients' characteristics played a decisive role in AKI prediction. Based on this result, we speculate that the selection of a specific pRBC may have less influence than recipient characteristics.
Collapse
Affiliation(s)
- Thomas Tschoellitsch
- From the Department of Anesthesiology and Critical Care Medicine, Kepler University, Hospital and Johannes Kepler University, Linz, Austria
| | - Philipp Moser
- Research Unit Medical Informatics, RISC Software GmbH, Hagenberg im Mühlkreis, Austria
| | - Alexander Maletzky
- Research Unit Medical Informatics, RISC Software GmbH, Hagenberg im Mühlkreis, Austria
| | - Philipp Seidl
- ELLIS Unit Linz, Linz Institute of Technology Artificial Intelligence Lab, Institute for Machine Learning, Johannes Kepler University, Linz, Austria
| | - Carl Böck
- Institute of Signal Processing, Johannes Kepler University, Linz, Austria
| | - Theresa Roland
- ELLIS Unit Linz, Linz Institute of Technology Artificial Intelligence Lab, Institute for Machine Learning, Johannes Kepler University, Linz, Austria
| | - Helga Ludwig
- ELLIS Unit Linz, Linz Institute of Technology Artificial Intelligence Lab, Institute for Machine Learning, Johannes Kepler University, Linz, Austria
| | - Susanne Süssner
- Transfusion Service and Blood Bank, Austrian Red Cross, District Branch of Upper Austria, Linz, Austria
| | - Sepp Hochreiter
- ELLIS Unit Linz, Linz Institute of Technology Artificial Intelligence Lab, Institute for Machine Learning, Johannes Kepler University, Linz, Austria
| | - Jens Meier
- From the Department of Anesthesiology and Critical Care Medicine, Kepler University, Hospital and Johannes Kepler University, Linz, Austria
| |
Collapse
|
2
|
Russell N, Al-Adli N, Shank C, Carey S, Ajayi O. Utility of routine type and cross for anterior cervical discectomy and fusion: A retrospective review. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100280. [PMID: 37915967 PMCID: PMC10616372 DOI: 10.1016/j.xnsj.2023.100280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/18/2023] [Accepted: 09/18/2023] [Indexed: 11/03/2023]
Abstract
Background Preoperative type and screen and type and cross are routinely obtained in patients undergoing elective cervical spine surgeries. This is despite low perioperative transfusion rates, particularly in patients undergoing anterior cervical discectomy and fusion (ACDF). Methods We conducted a retrospective cohort study at a single tertiary medical center of all patients 18 years of age or older undergoing elective ACDF for degenerative cervical spine disease between January 2016 and January 2021. Our primary outcome measures included the frequency of type and screen/crossmatch orders, rate of perioperative transfusion, and crossmatch to transfusion (C/T) ratio. Secondary outcomes included differences between preoperative and postoperative hemoglobin and hematocrit. Results In total, 1,162 patients were identified. There were no cases of intraoperative transfusion. The overall transfusion rate was less than 1%, with only 1 patient receiving a blood product transfusion during their hospital admission. This patient received 2 units of platelets for severe preoperative thrombocytopenia. Yet, 961 patients (83%) received ABO/Rh blood typing and screening and 647 patients (56%) had their blood typed and crossed. A total of 1,318 units of blood were crossmatched, with no units of packed red blood cells (pRBCs) transfused and only 2 units of platelets transfused, achieving a high crossmatch to transfusion (C/T) ratio of 659:1. Conclusions Among 1,162 patients who underwent elective ACDF at our institution, there were no patients who required an intraoperative or emergent blood transfusion. Furthermore, routine type and screen and crossmatch in patients undergoing elective ACDF at our insitution is associated with a high C/T ratio, suggestive of inefficient usage of blood products.
Collapse
Affiliation(s)
- Nicole Russell
- Anne Burnett School of Medicine, Texas Christian University, TCU Box 297085, Fort Worth, TX 76129, United States
| | - Nadeem Al-Adli
- Anne Burnett School of Medicine, Texas Christian University, TCU Box 297085, Fort Worth, TX 76129, United States
| | - Christopher Shank
- Anne Burnett School of Medicine, Texas Christian University, TCU Box 297085, Fort Worth, TX 76129, United States
- Department of Neurosurgery, Texas Health Harris Methodist Hospital, Fort Worth, TX 76104, United States
| | - Shannon Carey
- Department of Neurosurgery, Texas Health Harris Methodist Hospital, Fort Worth, TX 76104, United States
| | - Olaide Ajayi
- Anne Burnett School of Medicine, Texas Christian University, TCU Box 297085, Fort Worth, TX 76129, United States
- Department of Neurosurgery, Texas Health Harris Methodist Hospital, Fort Worth, TX 76104, United States
| |
Collapse
|
3
|
Volin J, Daniel J, Walter B, Herndon P, Tran D, Blumline J, Spillinger A, Karabon P, Fletcher C, Folbe A, Hafron J. Cost-effectiveness of routine type and screens in select urological surgeries. Int Urol Nephrol 2023; 55:823-833. [PMID: 36609935 DOI: 10.1007/s11255-022-03452-6] [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: 10/05/2022] [Accepted: 12/20/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE To evaluate the cost-effectiveness of obtaining a preoperative type and screen (T/S) for common urologic procedures. METHODS A decision tree model was constructed to track surgical patients undergoing two preoperative blood ordering strategies as follows: obtaining a preoperative T/S versus not doing so. The model was applied to the National (Nationwide) Inpatient Sample (NIS) data, from January 1, 2006 to September 30, 2015. Cost estimates for the model were created from combined patient-level data with published costs of a T/S, type and crossmatch (T/C), a unit of pRBC, and one unit of emergency-release transfusion (ERT). The primary outcome was the incremental cost per ERT prevented, expressed as an incremental cost-effectiveness ratio (ICER) between the two preoperative blood ordering strategies. A cost-effectiveness analysis determined the ICER of obtaining preoperative T/S to prevent an emergency-release transfusion (ERT), with a willingness-to-pay threshold of $1,500.00. RESULTS A total of 4,113,144 surgical admissions from 2006 to 2015 were reviewed. The overall transfusion rate was 10.54% (95% CI, 10.17-10.91) for all procedures. The ICER of preoperative T/S was $1500.00 per ERT prevented. One-way sensitivity analysis demonstrated that the risk of transfusion should exceed 4.12% to justify preoperative T/S. CONCLUSION Routine preoperative T/S for radical prostatectomy (rate = 3.88%) and penile implants (rate = .91%) does not represent a cost-effective practice for these surgeries. It is important for urologists to review their institution T/S policy to reduce inefficiencies within the preoperative setting.
Collapse
Affiliation(s)
- Joshua Volin
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA
| | - Joshua Daniel
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA
| | - Brianna Walter
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA.
| | - Patrick Herndon
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA
| | - Deanna Tran
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA
| | - James Blumline
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA
| | - Aviv Spillinger
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA
| | - Patrick Karabon
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA
| | - Craig Fletcher
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA
- Department of Urology, William Beaumont Hospital, Royal Oak, MI, 48073, USA
| | - Adam Folbe
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA
- Department of Urology, William Beaumont Hospital, Royal Oak, MI, 48073, USA
| | - Jason Hafron
- Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA
- Department of Urology, William Beaumont Hospital, Royal Oak, MI, 48073, USA
| |
Collapse
|
4
|
Red Blood Cell Transfusion in Patients With Placenta Accreta Spectrum: A Systematic Review and Meta-analysis. Obstet Gynecol 2023; 141:49-58. [PMID: 36701609 DOI: 10.1097/aog.0000000000004976] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/18/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate red blood cell use during delivery in patients with placenta accreta spectrum. DATA SOURCES We searched MEDLINE, EMBASE, CINAHL, Cochrane Central, ClinicalTrials.gov, and Scopus for clinical trials and observational studies published between 2000 and 2021 in countries with developed economies. METHODS OF STUDY SELECTION Abstracts (n=4,275) and full-text studies (n=599) were identified and reviewed by two independent reviewers. Data on transfused red blood cells were included from studies reporting means and SDs, medians with interquartile ranges, or individual patient data. The primary outcome was the weighted mean number of units of red blood cells transfused per patient. Between-study heterogeneity was assessed with an I2 statistic. Secondary analyses included red blood cell usage by placenta accreta subtype. TABULATION, INTEGRATION, AND RESULTS Of the 599 full-text studies identified, 20 met criteria for inclusion in the systematic review, comprising 1,091 cases of placenta accreta spectrum. The number of units of red blood cells transfused was inconsistently described across studies, with five studies (25.0%) reporting means, 11 (55.0%) reporting medians, and four (20.0%) reporting individual patient data. The weighted mean number of units transfused was 5.19 (95% CI 4.12-6.26) per patient. Heterogeneity was high across studies (I2=91%). In a sensitivity analysis of five studies reporting mean data, the mean number of units transfused was 6.61 (95% CI 4.73-8.48; n=220 patients). Further quantification of units transfused by placenta accreta subtype was limited due to methodologic inconsistencies between studies and small cohort sizes. CONCLUSION Based on the upper limit of the CI in our main analysis and the high study heterogeneity, we recommend that a minimum of 6 units of red blood cells be available before delivery for patients with placenta accreta spectrum. These findings may inform future guidelines for predelivery blood ordering and transfusion support. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021240993.
Collapse
|
5
|
Booth AT, Allen S, Simianu VV, Jensen CC, Schermerhorn ML, George VV, Curran T. Selective type & screen for elective colectomy based on a transfusion risk score may generate substantial cost savings. Surg Endosc 2022; 36:8817-8824. [PMID: 35616730 DOI: 10.1007/s00464-022-09307-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 04/25/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Preoperative type and screen are currently recommended for all patients undergoing colectomy. We aimed to identify risk factors for transfusion and define a low-risk cohort of patients undergoing colectomy in whom type and screen may be safely avoided. METHODS We identified all patients undergoing elective colectomy in the National Surgical Quality Improvement Project-Targeted Colectomy files from 2012 to 2016. Patients transfused preoperatively and those undergoing other concurrent major abdominal procedures were excluded. We compared patients who received blood transfusion on the day of surgery to those who did not. Half of the cohort was randomly selected for development of a points-based model predicting blood transfusion on the day of surgery. This model was then validated using the remaining patients. RESULTS Of 61,964 patients undergoing colectomy, 3128 (5%) patients were transfused with 1290 (2.1%) occurring on the day of surgery. Preoperative anemia was the strongest predictor of blood transfusion on the day of surgery. Among patients with hematocrit > 35%, day of surgery transfusion risk was 0.8%; 99% of patients with hematocrit > 35% had a score 20 or less. Selective type and screen for patients with score ≤ 20 or hematocrit > 35% would avoid type and screen in 91% and 81% of patients, respectively. CONCLUSION Transfusion following elective colectomy is rare and can be accurately predicted by preoperative patient characteristics. Selective type and screen based on these parameters have the potential to prevent operative delays and lower cost.
Collapse
Affiliation(s)
- Alexander T Booth
- Department of Surgery, Medical University of South Carolina, 30 Courtenay Drive, Suite 249, MSC 295, Charleston, SC, 29425, USA
| | - Shelby Allen
- Department of Surgery, Medical University of South Carolina, 30 Courtenay Drive, Suite 249, MSC 295, Charleston, SC, 29425, USA
| | - Vlad V Simianu
- Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA
| | | | - Marc L Schermerhorn
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Virgilio V George
- Department of Surgery, Medical University of South Carolina, 30 Courtenay Drive, Suite 249, MSC 295, Charleston, SC, 29425, USA
| | - Thomas Curran
- Department of Surgery, Medical University of South Carolina, 30 Courtenay Drive, Suite 249, MSC 295, Charleston, SC, 29425, USA.
| |
Collapse
|
6
|
Hasan RA, Hess AS, Hess JR. Preoperative coagulation testing and patient blood management. Transfusion 2022; 62:2155-2157. [PMID: 36239558 DOI: 10.1111/trf.17149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/04/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Rida A Hasan
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Aaron S Hess
- Department of Anesthesia, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Pathology & Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - John R Hess
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| |
Collapse
|
7
|
Zaremba RM, Brooks AC, Thomovsky EJ, Moore GE, Johnson PA. Comparison of a commercial immunochromatographic strip crossmatch kit and standard laboratory crossmatch methods for blood transfusion compatibility in dogs. J Vet Emerg Crit Care (San Antonio) 2022; 32:582-591. [PMID: 35838534 DOI: 10.1111/vec.13219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 04/28/2021] [Accepted: 05/19/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate agreement between 2 standard laboratory (SL) methods and an immunochromatographic strip (ICS) method to crossmatch dogs receiving RBC transfusions. A second objective was to evaluate uninterpretable SL crossmatch results as compared to ICS in the presence of autoagglutination. DESIGN Prospective observational study (September 2018 to October 2019). SETTING University teaching hospital. ANIMALS Forty anemic dogs receiving RBC transfusions. INTERVENTIONS None. MEASUREMENT AND MAIN RESULTS All dogs received DEA 1-negative packed RBCs. Three crossmatch methods were evaluated against the same unit transfused to each dog: SL method performed at institutional laboratory (SL-I), SL method sent to a commercial laboratory (SL-C), and a commercially available point-of-care ICS method. Major and minor crossmatches were incompatible for 2.5%/7.5% of ICS tests, 82.5%/52.5% of SL-I tests, and 52.5%/27.5% of SL-C tests. Agreement between ICS and SL-C major (κ = 0.05) and minor (κ = 0.02) crossmatches and between ICS and SL-I major (κ = 0.009) and minor (κ = 0.03) crossmatches was slight. Agreement between SL-C and SL-I major (κ = -0.06) and minor (κ = -0.12) crossmatches was poor. Results of major and minor crossmatches were uninterpretable due to autoagglutination in 38%/38% for SL-I and 29%/18% for SL-C crossmatches. ICS method was interpretable for 93% (major) and 98% (minor) crossmatches. After exclusion of uninterpretable SL pairings, agreement still remained poor to slight between all tests. Only 1 of 40 dogs (2.5%; 95% confidence interval: <1.0%-13.2%) had an immediate immunological transfusion reaction. CONCLUSIONS Lack of agreement between all methodologies was noted. The high level of incompatibility predicted by SL methods despite lack of clinically relevant reactions suggests a high false incompatibility rate as compared to the ICS test. ICS testing was also able to give results more frequently in the face of autoagglutination. Further work is needed to investigate the ICS method's ability to predict clinically significant transfusion reactions.
Collapse
Affiliation(s)
- Rebecca M Zaremba
- Emergency and Critical Care Department, IndyVet Emergency & Specialty Hospital, Indianapolis, Indiana, USA
| | - Aimee C Brooks
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, Indiana, USA
| | - Elizabeth J Thomovsky
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, Indiana, USA
| | - George E Moore
- Department of Veterinary Administration, Purdue University College of Veterinary Medicine, West Lafayette, Indiana, USA
| | - Paula A Johnson
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, Indiana, USA
| |
Collapse
|
8
|
Shared surgery blood reserve reduces surgery suspension rate due to blood unavailability. Transfus Apher Sci 2021; 61:103305. [PMID: 34772628 DOI: 10.1016/j.transci.2021.103305] [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: 04/12/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 11/23/2022]
Abstract
The hemotherapy service in health units with high surgical demand has been pointed out as a challenge, especially concerning storage management simultaneously with transfusion demand attendance. The objective of this study is to analyze service efficacy after the implementation of a new strategy to meet storage and transfusion demands. The present study analyzed the records of the hemotherapy service related to blood components management in surgeries where blood reserve was necessary for RhD positive patients at the National Institute of Traumatology and Orthopedics. A shared compatibility test and surgery reserve from the first semester of 2018 was compared to an equivalent period in 2017, prior to its implementation, under an individualized protocol to each patient scheduled on the surgery map. After the implementation of the shared protocol, the transfusion demand was higher, due to an increase in the percentage of surgeries that required transfusion, as well as to the augmented number of blood components used in the surgeries. Even in the presence of a slight decrease in storage, the hemotherapy assistance was considered efficient, since the percentage of surgery suspension reduced from 2 % to 0.2 % after the implementation of the shared protocol. This improvement resulted in an adjustment in the classification of reasons for surgical procedure cancellations, so that the reason "blood shortage" was repositioned from the first to the seventeenth position. This is the first record of a shared compatibility protocol and surgery reserve and we hope to contribute to the development of the hemotherapy service and surgical patient healthcare.
Collapse
|
9
|
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.
Collapse
Affiliation(s)
| | | | - Andrew C Bernard
- Department of Surgery, University of Kentucky, Lexington, Kentucky, USA
| |
Collapse
|
10
|
Amin RM, Puvanesarajah V, Chaudhry YP, Best MJ, Rao SS, Frank SM, Hasenboehler EA. Reducing unnecessary crossmatching for hip fracture patients by accounting for preoperative hemoglobin concentration. World J Orthop 2021; 12:292-300. [PMID: 34055586 PMCID: PMC8152439 DOI: 10.5312/wjo.v12.i5.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/18/2021] [Accepted: 04/09/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Maximum surgical blood order schedules were designed to eliminate unnecessary preoperative crossmatching prior to surgery in order to conserve blood bank resources. Most protocols recommend type and cross of 2 red blood cell (RBC) units for patients undergoing surgery for treatment of hip fracture. Preoperative hemoglobin has been identified as the strongest predictor of inpatient transfusion, but current maximum surgical blood order schedules do not consider preoperative hemoglobin values to determine the number of RBC units to prepare prior to surgery.
AIM To determine the preoperative hemoglobin level resulting in the optimal 2:1 crossmatch-to-transfusion (C:T) ratio in hip fracture surgery patients.
METHODS In 2015 a patient blood management (PBM) program was implemented at our institution mandating a single unit-per-occurrence transfusion policy and a restrictive transfusion threshold of < 7 g/dL hemoglobin in asymptomatic patients and < 8 g/dL in those with refractory symptomatic anemia or history of coronary artery disease. We identified all hip fracture patients between 2013 and 2017 and compared the preoperative hemoglobin which would predict a 2:1 C:T ratio in the pre PBM and post PBM cohorts. Prediction profiling and sensitivity analysis were performed with statistical significance set at P < 0.05.
RESULTS Four hundred and ninety-eight patients who underwent hip fracture surgery between 2013 and 2017 were identified, 291 in the post PBM cohort. Transfusion requirements in the post PBM cohort were lower (51% vs 33%, P < 0.0001) than in the pre PBM cohort. The mean RBC units transfused per patient was 1.15 in the pre PBM cohort, compared to 0.66 in the post PBM cohort (P < 0.001). The 2:1 C:T ratio (inpatient transfusion probability of 50%) was predicted by a preoperative hemoglobin of 12.3 g/dL [area under the curve (AUC) 0.78 (95% confidence interval (CI), 0.72-0.83), Sensitivity 0.66] in the pre PBM cohort and 10.7 g/dL [AUC 0.78 (95%CI, 0.73-0.83), Sensitivity 0.88] in the post PBM cohort. A 50% probability of requiring > 1 RBC unit was predicted by 11.2g/dL [AUC 0.80 (95%CI, 0.74-0.85), Sensitivity 0.87] in the pre PBM cohort and 8.7g/dL [AUC 0.78 (95%CI, 0.73-0.83), Sensitivity 0.84] in the post-PBM cohort.
CONCLUSION The hip fracture maximum surgical blood order schedule should consider preoperative hemoglobin in determining the number of units to type and cross prior to surgery.
Collapse
Affiliation(s)
- Raj M Amin
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA 94305, United States
| | - Varun Puvanesarajah
- Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21205, United States
| | - Yash P Chaudhry
- Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA 19122, United States
| | - Matthew J Best
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MD 02114, United States
| | - Sandesh S Rao
- Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21205, United States
| | - Steven M Frank
- Department of Anesthesiology, Critical Care Medicine, Baltimore, MD 21205, United States
| | - Erik A Hasenboehler
- Department of Orthopaedics, Johns Hopkins School of Medicine, Baltimore, MD 21205, United States
| |
Collapse
|
11
|
Moghaddamahmadi M, Khoshrang H, Khatami SS, Hooshmand Marvasti A, Ghovvati Choshal H, Mehrkhah S. Survey of Maximum Blood Ordering for Surgery (MSBOS) in elective general surgery, neurosurgery and orthopedic surgery at the Poursina Hospital in Rasht, Iran, 2017. Hematol Transfus Cell Ther 2020; 43:482-488. [PMID: 33077398 PMCID: PMC8573079 DOI: 10.1016/j.htct.2020.07.012] [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: 05/02/2020] [Revised: 06/26/2020] [Accepted: 07/15/2020] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Blood is a valuable life resource that depends on the donation of blood by the community. As a result, it is crucial that the manner in which this expensive resource is used be correct and reasonable. OBJECTIVE The purpose of this study was to investigate the Maximum Blood Ordering for Surgery (MSBOS) in general, orthopedic and neurosurgical elective surgeries at the Poursina Hospital in Rasht in 2017. METHODS According to the patient file number information, such as gender, age, type of surgery, number of blood units requested, number of cross-matched blood units, number of blood units transfusion, number of patients undergoing transfusion, number of patients who were cross-matched, initial hemoglobin and the underlying disease, was extracted from the HIS (Hospital Information System). Based on the collected data, a descriptive report of the cross-match to transfusion ratio (C/T), transfusion index (TI) and transfusion probability (%T) was performed, using average and standard deviation, by using the SPSS 16. RESULTS In the present study, 914 patients from the neurosurgery, orthopedic and general surgery wards of the Poursina Hospital were studied. Of these, 544 were male (59.5%) and 370 were female (40.5%), aged 1-99 years, with a mean age of 43 years. The frequency distribution of C/T in this study was 1.29 in neurosurgery, 1.95 in orthopedic surgery and 1.96 in general surgery. This study indicated that the C/T index was above the normal standard level in four different kinds of surgery, including leg fracture (2.71), cholecystectomy(2.71), forearm fracture (2.70), and skin graft (2.62).The C/T index was at the maximum normal level in thyroidectomy surgery (2.5). The other surgeries had the normal C/T index. CONCLUSION Overall, all of the MSBOS indices were at the standard level in this study, although C/T indices were higher than the standard level in the surgeries for cholecystectomy, leg fracture, forearm fracture, hand fracture and skin graft.
Collapse
|
12
|
Vanneman MW, Balakrishna A, Lang AL, Eliason KD, Payette AM, Xu X, Driscoll WD, Donovan KM, Deng H, Dzik WH, Levine WC. Improving Transfusion Safety in the Operating Room With a Barcode Scanning System Designed Specifically for the Surgical Environment and Existing Electronic Medical Record Systems: An Interrupted Time Series Analysis. Anesth Analg 2020; 131:1217-1227. [PMID: 32925343 DOI: 10.1213/ane.0000000000005084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Manual processes for verifying patient identification before blood transfusion and documenting this pretransfusion safety check are prone to errors, and compliance with manual systems is especially poor in urgent operating room settings. An automated, electronic barcode scanner system would be expected to improve pretransfusion verification and documentation. METHODS Audits were conducted of blood transfusion documentation under a manual paper system from January to October 2014. An electronic barcode scanning system was developed to streamline transfusion safety checking and automate documentation. This system was implemented in 58 operating rooms between October and December 2014, with follow-up compliance audits through December 2015. The association of barcode scanner implementation with transfusion documentation compliance was assessed using an interrupted time series analysis. Anesthesia providers were surveyed regarding their opinions on the electronic system. In mid-2016, the scanning system was modified to transfer from the Metavision medical record system to Epic OpTime. Follow-up analysis assessed performance of this system within Epic during 2017. RESULTS In an interrupted time series analysis, the proportion of units with compliant documentation was estimated to be 19.6% (95% confidence interval [CI], 10.7-25.6) the week before scanner implementation, and 74.4% (95% CI, 59.4-87.4) the week after implementation. There was a significant postintervention level change (odds ratio 10.80, 95% CI, 6.31-18.70; P < .001) and increase in slope (odds ratio 1.14 per 1-week increase, 95% CI, 1.11-1.17; P < .001). After implementation, providers chose to use the new electronic system for 98% of transfusions. Across the 2 years analyzed (15,997 transfusions), the electronic system detected 45 potential transfusion errors in 27 unique patients, and averted transfusion of 36 mismatched blood products into 20 unique patients. A total of 69%, 86%, and 88% of providers reported the electronic system improved patient safety, blood transfusion workflow, and transfusion documentation, respectively. When providers used the barcode scanner, no transfusion errors or reactions were reported. The scanner system was successfully transferred from Metavision to Epic without retraining staff or changing workflows. CONCLUSIONS A barcode-based system designed for easy integration to different commonly used anesthesia information management systems was implemented in a large urban academic hospital. The system allows a single user with the assistance of a software system to perform and document pretransfusion safety verification. The system improved transfusion documentation compliance, averted potential transfusion errors, and became the preferred method of blood transfusion safety checking.
Collapse
Affiliation(s)
| | | | - Angela L Lang
- From the Department of Anesthesia, Critical Care and Pain Medicine
| | - Kent D Eliason
- The Blood Transfusion Service, Massachusetts General Hospital, Boston, Massachusetts
| | - Alyssa M Payette
- From the Department of Anesthesia, Critical Care and Pain Medicine
| | - Xiaojun Xu
- From the Department of Anesthesia, Critical Care and Pain Medicine
| | | | | | - Hao Deng
- From the Department of Anesthesia, Critical Care and Pain Medicine
| | - Walter H Dzik
- The Blood Transfusion Service, Massachusetts General Hospital, Boston, Massachusetts
| | - Wilton C Levine
- From the Department of Anesthesia, Critical Care and Pain Medicine
| |
Collapse
|
13
|
Gupta N, Visagie M, Kajstura TJ, Han M, Trock B, Gehrie EA, Frank SM, Bivalacqua TJ. Reducing preoperative blood orders and costs for radical prostatectomy. J Comp Eff Res 2020; 9:219-226. [PMID: 32043362 DOI: 10.2217/cer-2019-0126] [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] [Indexed: 11/21/2022] Open
Abstract
Aim: A maximum surgical blood order schedule (MSBOS) was implemented at our institution to optimize preoperative blood ordering and reduce unnecessary blood preparation for patients undergoing radical prostatectomy (RP), a common urologic procedure. Materials & methods: We conducted a retrospective review of patients who underwent RP from 2010 to 2016 and categorized patients by date of RP (pre- or post-MSBOS) and compared preoperative blood-ordering practices. Results: After MSBOS implementation, preoperative blood orders changed from predominantly type and cross-match 2 units (53%) to no sample (56%) for robot-assisted laparoscopic RP, and from mostly type and cross-match 2 units (62%) to type and screen (75%) for open RP with resultant cost savings. Conclusion: MSBOS implementation and compliance decreases unnecessary preoperative blood orders.
Collapse
Affiliation(s)
- Natasha Gupta
- The James Buchanan Brady Urological Institute & Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Mereze Visagie
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Tymoteusz J Kajstura
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Misop Han
- The James Buchanan Brady Urological Institute & Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Bruce Trock
- The James Buchanan Brady Urological Institute & Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Eric A Gehrie
- Department of Pathology (Transfusion Medicine), Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Steven M Frank
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Trinity J Bivalacqua
- The James Buchanan Brady Urological Institute & Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| |
Collapse
|
14
|
Dorenkamp BC, Janssen MK, Janssen ME. Improving blood product utilization at an ambulatory surgery center: a retrospective cohort study on 50 patients with lumbar disc replacement. Patient Saf Surg 2020; 13:45. [PMID: 31890030 PMCID: PMC6921547 DOI: 10.1186/s13037-019-0226-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 12/09/2019] [Indexed: 11/26/2022] Open
Abstract
Background There is minimal literature discussing anterior lumbar spine surgery in ambulatory surgery centers (ASCs). The main concern with the anterior approach to the lumbar spine is the potential for injury to great vessels. In our facility, there are two units of crossmatched blood available in addition to cell saver during the procedure. We retrospectively looked at 50 cases of lumbar total disc arthroplasty (TDA) in our ASC to determine utilization of blood products. Methods Medical records of 50 consecutive patients who underwent a lumbar TDA at a single ASC were reviewed. Surgeries completed at the ASC were all transferred from the post anesthesia care unit to an attached convalescence care center which allows up to 3 days of observation. Patients who had either a 1 or 2 level lumbar TDA were included in the study. Data consisting of demographics, American Society of Anesthesiologist Physical Status Classification System, length of stay, estimated blood loss, cell saver volume, transfusion, perioperative and postoperative complications were recorded. Preoperative, perioperative and postoperative medical records were reviewed. Results Medical records of 50 consecutive patients were reviewed. The mean age was 40.86 ± 9.45. Of these, 48 (96%) had a 1-level lumbar TDA, 1(2%) had a 2-level lumbar TDA, 1 (2%) had a lumbar TDA at L4/5 and an anterior lumbar interbody fusion at L5/S1. There were no mortalities; no patient had recorded perioperative complications. No patients received allogeneic blood transfusion, 4 (8%) were re-transfused with cell saver (2 receiving approximately 400 ml and 2 receiving approximately 200 ml of re-transfused blood). All 50 (100%) were discharged home in stable condition. We had 30-day follow-up data on 35 of 50 patients. Of the 35 patients reviewed, three (8.5%) of the patients were readmitted to the hospital. One additional patient was seen in the emergency department and discharged home after negative testing. No patient was readmitted for post-operative anemia. Conclusion The routine use of both cell saver and crossmatched blood in the operating suite for lumbar TDA may be an over-utilization of healthcare resources. In our review of 50 patients, we had no need for transfusion of allogeneic packed red blood cells (PRBCs) and only four of the 50 patients had enough blood output for re-transfusion from the cell saver. This opens the conversation for alternatives to crossmatched PRBCs being held in the operating room. Such alternatives may be the use of cell salvage, only type O blood in a cooler for each patient or keeping type O blood on constant hold in ASCs.
Collapse
Affiliation(s)
- Benjamin C Dorenkamp
- 1Orthopedic Surgery Residency, McLaren Greater Lansing, 401 W Greenlawn Ave, Lansing, MI 48910 USA
| | - Madisen K Janssen
- 2College of Osteopathic Medicine, Rocky Vista University, 8401 S Chambers Rd, Parker, CO 80134 USA
| | - Michael E Janssen
- Center for Spine & Orthopedics, 9005 Grant St #200, Denver, CO 80229 USA
| |
Collapse
|
15
|
Marcondes SS, Carrareto AR, da Penha Zago-Gomes M, do Perpétuo Socorro Vendramini Orletti M, Novaes ACZL. Evaluation of the use of blood in surgeries as a tool to change patterns for requesting blood product reserves. Clinics (Sao Paulo) 2019; 74:e652. [PMID: 31038643 PMCID: PMC6467177 DOI: 10.6061/clinics/2019/e652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 01/08/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Thirty to sixty percent of prepared blood products are not transfused. Blood reserves for surgeries lead to many unused blood products, which increases hospital costs. The aim of this study is to identify the request and use profiles of blood products for elective surgeries in different surgical specialties, the influence of surgery time and demographic, clinical, and laboratory variables on the number of red blood cells (RBCs) used and to calculate the rate of transfused patients (RTP) and cross-matched and transfused (C/T) RBCs. METHODS Observational and prospective studies. Sociodemographic, clinical and quantitative data on the request and use of blood products were collected. The influence of the data on the use of RBCs was examined by binary logistic regression. Chi-square, one-way ANOVA and Kruskal-Wallis tests were utilized to compare the data among the specialties. RESULTS In total, 822 procedures were included. Most of the requested blood products were not used, even 24 hours postoperatively. Of the 2,483 RBC units, 314 were transfused, leaving 87.6% unused; however, cardiac, digestive tract, vascular, gynecologic, urologic and thoracic surgery procedures transfused 50%, 25%, 16.5%, 11%, 9.5% and 8.1% of requested RBCs, respectively. The factors that influenced the transfusions were age, time of surgery and cardiac surgeries. The RTP was >10% in 22 surgical types and <1% in 24 surgical types, and 88% of samples presented a C/T ratio >2.5. CONCLUSION The RTP and C/T ratios can guide RBC requests in the preoperative period. Knowing the standard of use of blood products and developing protocols enables the optimization of reserves, reduction of costs and improvement of care.
Collapse
Affiliation(s)
- Sibia Soraya Marcondes
- Hospital Universitario Cassiano Antonio Moraes, Vitoria, ES, BR
- Faculdade de Medicina, Escola Superior de Ciencias da Santa Casa de Misericordia de Vitoria, Vitoria, ES, BR
- Corresponding author. E-mail:
| | | | | | | | | |
Collapse
|
16
|
Isidoro REC, Silva KFND, Oliveira JFD, Barichello E, Pires PDS, Barbosa MH. BLOOD ORDERS AND PREDICTORS FOR HEMOTRANSFUSION IN ELECTIVE FEMUR FRACTURE REPAIR SURGERY. TEXTO & CONTEXTO ENFERMAGEM 2019. [DOI: 10.1590/1980-265x-tce-2018-0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to estimate the incidence of red blood cell concentrate orders in elective femur fracture repair surgeries and to identify predictors for hemotranfusion. Method: retrospective cohort study conducted with 271 patients submitted to femur fracture repair surgery between July 2013 and July 2016. Surgical and transfusion data were obtained from patient charts and the Transfusion Management System. Association between sociodemographic and clinical variables related to the surgical procedure and the occurrence of red blood cell concentrate transfusion was analyzed using descriptive statistics, the chi-squared test, relative risk, and odds ratio. Multivariate analysis was performed using binomial logistic regression. Results: the incidence of blood orders for patients undergoing femur fracture repair surgery was 87%. Ninety-one (33.6%) patients received red blood cell concentrate transfusions. Even though placing blood orders is recommended, given the possibility of intra- or postoperative transfusions, only 52 (47.2%) blood transfusions occurred in the preoperative period. The variables female sex, low preoperative hemoglobin levels and procedure lasting longer than 120 minutes presented statistical significance (p<0.05) and were considered predictors for hemototransfusion. Conclusion: Perioperative nursing must be aware of the importance of blood orders for all patients undergoing femur fracture repair surgery, including in the preoperative period, with special attention to patients who are female, previously anemic and submitted to long-lasting procedures.
Collapse
|
17
|
Blank RM, Blank SP, Roberts HE. An audit of perioperative blood transfusions in a regional hospital to rationalise a maximum surgical blood ordering schedule. Anaesth Intensive Care 2018; 46:498-503. [PMID: 30189824 DOI: 10.1177/0310057x1804600511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Appropriate preoperative blood typing and cross-matching is an important quality improvement target to minimise costs and rationalise the use of blood bank resources. This can be facilitated using a maximum surgical blood ordering schedule (MSBOS) for specific operations. It is recommended that individual hospitals develop a site-specific MSBOS based on institutional data, but this is challenging in non-tertiary centres without electronic databases. Our aim was to audit our perioperative blood transfusions to develop a site-specific MSBOS. A retrospective audit of blood transfusions in surgical patients in our regional referral hospital was conducted using five years' coded administrative data. Procedures with higher transfusion rates warranting preoperative testing (type and screen with or without subsequent cross-matching) were identified. There were about 15,000 eligible surgical procedures performed in our institution over the audit period. The need for preoperative testing was identified for only a few procedures, namely laparotomy, bowel resection, major amputation, joint arthroplasty, hip/femur fracture and humerus surgery, and procedures for obstetric complications. We observed a reduction in transfusion rates over time for total joint arthroplasty. The use of coding data represents an efficient method by which centres without electronic anaesthesia information management systems can conduct large-scale audits to develop a site-specific MSBOS. This would represent a significant improvement for hospitals that currently base preoperative testing recommendations on expert opinion alone. As many procedures in regional centres have very low transfusion rates, hospitals with a similar case mix to ours could consider selectively auditing higher-risk operations where local data is most likely to alter testing recommendations.
Collapse
Affiliation(s)
| | | | - H E Roberts
- University of Melbourne, Rural Clinical School; Shepparton, Victoria
| |
Collapse
|
18
|
Patel SY, Edwards DA, Boulware DC, Serdiuk A, Cook SJ, Benson K, Rice MJ. A novel approach to improving efficiency and cost saving in preoperative blood preparation. Transfusion 2017; 57:3035-3039. [PMID: 28940392 DOI: 10.1111/trf.14331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 07/31/2017] [Accepted: 07/31/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Preoperative ordering of blood products has been an area of optimization due to considerable variability among physicians; overpreparation can lead to extra costs and underpreparation of blood can potentially compromise patient safety. STUDY DESIGN AND METHODS We examined the potential cost savings of extending the storage interval of a presurgical type-and-screen sample from 7 to 14 days, thereby reducing the need for a new specimen on the day of surgery. RESULTS Sensitivity analysis showed annual cost savings for our institution to be an estimated $38,770 ($22,420-$73,120). CONCLUSION These results are even more robust when incorporating the additional potential savings from improved operating room efficiency.
Collapse
Affiliation(s)
- Sephalie Y Patel
- Department of Anesthesiology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - David A Edwards
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - David C Boulware
- Department of Biostatistics, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Andrew Serdiuk
- Department of Anesthesiology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Susan J Cook
- Blood Bank, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Kaaron Benson
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Mark J Rice
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| |
Collapse
|
19
|
Pustavoitau A, Lesley M, Ariyo P, Latif A, Villamayor AJ, Frank SM, Rizkalla N, Merritt W, Cameron A, Dagher N, Philosophe B, Gurakar A, Gottschalk A. Predictive Modeling of Massive Transfusion Requirements During Liver Transplantation and Its Potential to Reduce Utilization of Blood Bank Resources. Anesth Analg 2017; 124:1644-1652. [DOI: 10.1213/ane.0000000000001994] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
20
|
Health Policy, Ethical, Business, and Financial Issues Related to Blood Management in Orthopedics. Tech Orthop 2017. [DOI: 10.1097/bto.0000000000000210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
21
|
Özen M, Erkul S, Erkul GSA, Genç Ö, Akgül E, Vural AH. Therapeutic Plasma Exchange Ameliorates Incompatible Crossmatches. Turk J Haematol 2016; 33:356-358. [PMID: 27751982 PMCID: PMC5204197 DOI: 10.4274/tjh.2016.0056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Mehmet Özen
- Dumlupınar University Faculty of Medicine, Department of Hematology, Kütahya, Turkey, Phone: +90 274 231 66 60, E-mail:
| | | | | | | | | | | |
Collapse
|
22
|
Thompson RM, Thurm CW, Rothstein DH. Interhospital Variability in Perioperative Red Blood Cell Ordering Patterns in United States Pediatric Surgical Patients. J Pediatr 2016; 177:244-249.e5. [PMID: 27453372 DOI: 10.1016/j.jpeds.2016.06.080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 05/16/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate perioperative red blood cell (RBC) ordering and interhospital variability patterns in pediatric patients undergoing surgical interventions at US children's hospitals. STUDY DESIGN This is a multicenter cross-sectional study of children aged <19 years admitted to 38 pediatric tertiary care hospitals participating in the Pediatric Health Information System in 2009-2014. Only cases performed at all represented hospitals were included in the study, to limit case mix variability. Orders for blood type and crossmatch were included when done on the day before or the day of the surgical procedure. The RBC transfusions included were those given on the day of or the day after surgery. The type and crossmatch-to-transfusion ratio (TCTR) was calculated for each surgical procedure. An adjusted model for interhospital variability was created to account for variation in patient population by age, sex, race/ethnicity, payer type, and presence/number of complex chronic conditions (CCCs) per patient. RESULTS A total of 357 007 surgical interventions were identified across all participating hospitals. Blood type and crossmatch was performed 55 632 times, and 13 736 transfusions were provided, for a TCTR of 4:1. There was an association between increasing age and TCTR (R(2) = 0.43). Patients with multiple CCCs had lower TCTRs, with a stronger relationship (R(2) = 0.77). There was broad variability in adjusted TCTRs among hospitals (range, 2.5-25). CONCLUSIONS The average TCTR in US children's hospitals was double that of adult surgical data, and was associated with wide interhospital variability. Age and the presence of CCCs markedly influenced this ratio. Studies to evaluate optimal preoperative RBC ordering and standardization of practices could potentially decrease unnecessary costs and wasted blood.
Collapse
Affiliation(s)
- Rachel M Thompson
- Department of Orthopedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, TX
| | - Cary W Thurm
- Children's Hospital Association, Overland Park, KS
| | - David H Rothstein
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo and University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY.
| |
Collapse
|