Comprehensive multimodality blood conservation

100 consecutive CABG operations without transfusion

Robert E. Helm, Todd K. Rosengart, Maureen Gomez, John D. Klemperer, William J. DeBois, Ferdinand Velasco, Jeffrey P Gold, Nasser K. Altorki, Samuel Lang, Stephen Thomas, O. Wayne Isom, Karl H. Krieger

Research output: Contribution to journalArticle

110 Citations (Scopus)

Abstract

Background. Despite the recent introduction of a number of technical and pharmacologic blood conservation measures, bleeding and allogeneic transfusion remain persistent problems in open heart surgical procedures. We hypothesized that a comprehensive multimodality blood conservation program applied algorithmically on the basis of bleeding and transfusion risk would provide a maximum, cost-effective, and safe reduction in postoperative bleeding and allogeneic blood transfusion. Methods. One hundred consecutive patients undergoing coronary artery bypass grafting were prospectively enrolled in a risk factor-based multimodality blood conservation program (MMD group). To evaluate the relative efficacy and safety of this comprehensive approach, comparison was made with a similar group of 90 patients undergoing coronary artery bypass grafting to whom the multimodality blood conservation program was not applied but in whom an identical set of transfusion guidelines was enforced (control group). To evaluate the cost effectiveness of the multimodality program, comparison was also made between patients in the MMD group and a consecutive series of contemporaneous, diagnostic- related group-matched patients. Results. One hundred consecutive patients in the MMD group underwent coronary artery bypass grafting without allogeneic transfusion. This compared favorably with the control population in whom a mean of 2.2 ± 6.7 units of allogeneic blood was transfused per patient (34 patients [38%] received transfusion). In addition, the volume of postoperative blood loss at 12 hours in the control group was almost double that of the MMD group (660 ± 270 mL versus 370 ± 180 mL [p < 0.001]). Total costs for the MMD group in each of the three major diagnostic-related groups were equivalent to or significantly less than those in the consecutive series of diagnostic-related group-matched patients. Conclusions. Comprehensive risk factor-based application of multiple blood conservation measures in an optimized, integrated, and algorithmic manner can significantly decrease bleeding and need of allogeneic transfusion in coronary artery bypass grafting in a safe and cost-effective manner.

Original languageEnglish (US)
Pages (from-to)125-136
Number of pages12
JournalAnnals of Thoracic Surgery
Volume65
Issue number1
DOIs
StatePublished - Jan 1 1998

Fingerprint

Coronary Artery Bypass
Diagnosis-Related Groups
Hemorrhage
Costs and Cost Analysis
Cardiac Surgical Procedures
Postoperative Hemorrhage
Control Groups
Blood Transfusion
Cost-Benefit Analysis
Guidelines
Safety
Population

ASJC Scopus subject areas

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

Cite this

Helm, R. E., Rosengart, T. K., Gomez, M., Klemperer, J. D., DeBois, W. J., Velasco, F., ... Krieger, K. H. (1998). Comprehensive multimodality blood conservation: 100 consecutive CABG operations without transfusion. Annals of Thoracic Surgery, 65(1), 125-136. https://doi.org/10.1016/S0003-4975(97)01004-7

Comprehensive multimodality blood conservation : 100 consecutive CABG operations without transfusion. / Helm, Robert E.; Rosengart, Todd K.; Gomez, Maureen; Klemperer, John D.; DeBois, William J.; Velasco, Ferdinand; Gold, Jeffrey P; Altorki, Nasser K.; Lang, Samuel; Thomas, Stephen; Isom, O. Wayne; Krieger, Karl H.

In: Annals of Thoracic Surgery, Vol. 65, No. 1, 01.01.1998, p. 125-136.

Research output: Contribution to journalArticle

Helm, RE, Rosengart, TK, Gomez, M, Klemperer, JD, DeBois, WJ, Velasco, F, Gold, JP, Altorki, NK, Lang, S, Thomas, S, Isom, OW & Krieger, KH 1998, 'Comprehensive multimodality blood conservation: 100 consecutive CABG operations without transfusion', Annals of Thoracic Surgery, vol. 65, no. 1, pp. 125-136. https://doi.org/10.1016/S0003-4975(97)01004-7
Helm, Robert E. ; Rosengart, Todd K. ; Gomez, Maureen ; Klemperer, John D. ; DeBois, William J. ; Velasco, Ferdinand ; Gold, Jeffrey P ; Altorki, Nasser K. ; Lang, Samuel ; Thomas, Stephen ; Isom, O. Wayne ; Krieger, Karl H. / Comprehensive multimodality blood conservation : 100 consecutive CABG operations without transfusion. In: Annals of Thoracic Surgery. 1998 ; Vol. 65, No. 1. pp. 125-136.
@article{c1bf3413e53e4f8ab74dd93f6f83dade,
title = "Comprehensive multimodality blood conservation: 100 consecutive CABG operations without transfusion",
abstract = "Background. Despite the recent introduction of a number of technical and pharmacologic blood conservation measures, bleeding and allogeneic transfusion remain persistent problems in open heart surgical procedures. We hypothesized that a comprehensive multimodality blood conservation program applied algorithmically on the basis of bleeding and transfusion risk would provide a maximum, cost-effective, and safe reduction in postoperative bleeding and allogeneic blood transfusion. Methods. One hundred consecutive patients undergoing coronary artery bypass grafting were prospectively enrolled in a risk factor-based multimodality blood conservation program (MMD group). To evaluate the relative efficacy and safety of this comprehensive approach, comparison was made with a similar group of 90 patients undergoing coronary artery bypass grafting to whom the multimodality blood conservation program was not applied but in whom an identical set of transfusion guidelines was enforced (control group). To evaluate the cost effectiveness of the multimodality program, comparison was also made between patients in the MMD group and a consecutive series of contemporaneous, diagnostic- related group-matched patients. Results. One hundred consecutive patients in the MMD group underwent coronary artery bypass grafting without allogeneic transfusion. This compared favorably with the control population in whom a mean of 2.2 ± 6.7 units of allogeneic blood was transfused per patient (34 patients [38{\%}] received transfusion). In addition, the volume of postoperative blood loss at 12 hours in the control group was almost double that of the MMD group (660 ± 270 mL versus 370 ± 180 mL [p < 0.001]). Total costs for the MMD group in each of the three major diagnostic-related groups were equivalent to or significantly less than those in the consecutive series of diagnostic-related group-matched patients. Conclusions. Comprehensive risk factor-based application of multiple blood conservation measures in an optimized, integrated, and algorithmic manner can significantly decrease bleeding and need of allogeneic transfusion in coronary artery bypass grafting in a safe and cost-effective manner.",
author = "Helm, {Robert E.} and Rosengart, {Todd K.} and Maureen Gomez and Klemperer, {John D.} and DeBois, {William J.} and Ferdinand Velasco and Gold, {Jeffrey P} and Altorki, {Nasser K.} and Samuel Lang and Stephen Thomas and Isom, {O. Wayne} and Krieger, {Karl H.}",
year = "1998",
month = "1",
day = "1",
doi = "10.1016/S0003-4975(97)01004-7",
language = "English (US)",
volume = "65",
pages = "125--136",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "1",

}

TY - JOUR

T1 - Comprehensive multimodality blood conservation

T2 - 100 consecutive CABG operations without transfusion

AU - Helm, Robert E.

AU - Rosengart, Todd K.

AU - Gomez, Maureen

AU - Klemperer, John D.

AU - DeBois, William J.

AU - Velasco, Ferdinand

AU - Gold, Jeffrey P

AU - Altorki, Nasser K.

AU - Lang, Samuel

AU - Thomas, Stephen

AU - Isom, O. Wayne

AU - Krieger, Karl H.

PY - 1998/1/1

Y1 - 1998/1/1

N2 - Background. Despite the recent introduction of a number of technical and pharmacologic blood conservation measures, bleeding and allogeneic transfusion remain persistent problems in open heart surgical procedures. We hypothesized that a comprehensive multimodality blood conservation program applied algorithmically on the basis of bleeding and transfusion risk would provide a maximum, cost-effective, and safe reduction in postoperative bleeding and allogeneic blood transfusion. Methods. One hundred consecutive patients undergoing coronary artery bypass grafting were prospectively enrolled in a risk factor-based multimodality blood conservation program (MMD group). To evaluate the relative efficacy and safety of this comprehensive approach, comparison was made with a similar group of 90 patients undergoing coronary artery bypass grafting to whom the multimodality blood conservation program was not applied but in whom an identical set of transfusion guidelines was enforced (control group). To evaluate the cost effectiveness of the multimodality program, comparison was also made between patients in the MMD group and a consecutive series of contemporaneous, diagnostic- related group-matched patients. Results. One hundred consecutive patients in the MMD group underwent coronary artery bypass grafting without allogeneic transfusion. This compared favorably with the control population in whom a mean of 2.2 ± 6.7 units of allogeneic blood was transfused per patient (34 patients [38%] received transfusion). In addition, the volume of postoperative blood loss at 12 hours in the control group was almost double that of the MMD group (660 ± 270 mL versus 370 ± 180 mL [p < 0.001]). Total costs for the MMD group in each of the three major diagnostic-related groups were equivalent to or significantly less than those in the consecutive series of diagnostic-related group-matched patients. Conclusions. Comprehensive risk factor-based application of multiple blood conservation measures in an optimized, integrated, and algorithmic manner can significantly decrease bleeding and need of allogeneic transfusion in coronary artery bypass grafting in a safe and cost-effective manner.

AB - Background. Despite the recent introduction of a number of technical and pharmacologic blood conservation measures, bleeding and allogeneic transfusion remain persistent problems in open heart surgical procedures. We hypothesized that a comprehensive multimodality blood conservation program applied algorithmically on the basis of bleeding and transfusion risk would provide a maximum, cost-effective, and safe reduction in postoperative bleeding and allogeneic blood transfusion. Methods. One hundred consecutive patients undergoing coronary artery bypass grafting were prospectively enrolled in a risk factor-based multimodality blood conservation program (MMD group). To evaluate the relative efficacy and safety of this comprehensive approach, comparison was made with a similar group of 90 patients undergoing coronary artery bypass grafting to whom the multimodality blood conservation program was not applied but in whom an identical set of transfusion guidelines was enforced (control group). To evaluate the cost effectiveness of the multimodality program, comparison was also made between patients in the MMD group and a consecutive series of contemporaneous, diagnostic- related group-matched patients. Results. One hundred consecutive patients in the MMD group underwent coronary artery bypass grafting without allogeneic transfusion. This compared favorably with the control population in whom a mean of 2.2 ± 6.7 units of allogeneic blood was transfused per patient (34 patients [38%] received transfusion). In addition, the volume of postoperative blood loss at 12 hours in the control group was almost double that of the MMD group (660 ± 270 mL versus 370 ± 180 mL [p < 0.001]). Total costs for the MMD group in each of the three major diagnostic-related groups were equivalent to or significantly less than those in the consecutive series of diagnostic-related group-matched patients. Conclusions. Comprehensive risk factor-based application of multiple blood conservation measures in an optimized, integrated, and algorithmic manner can significantly decrease bleeding and need of allogeneic transfusion in coronary artery bypass grafting in a safe and cost-effective manner.

UR - http://www.scopus.com/inward/record.url?scp=0031907526&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031907526&partnerID=8YFLogxK

U2 - 10.1016/S0003-4975(97)01004-7

DO - 10.1016/S0003-4975(97)01004-7

M3 - Article

VL - 65

SP - 125

EP - 136

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 1

ER -