Less (Transfusion) Is More-Enhancing Recovery through Implementation of Patient Blood Management in Cardiac Surgery: A Retrospective, Single-Centre Study of 1174 Patients

• Published in: Journal of cardiovascular development and disease 2023-06, Vol.10 (7), p.266
• Main Authors: Ștefan, Mihai, Tomescu, Dana, Predoi, Cornelia, Goicea, Raluca, Perescu, Mihai, Popescu, Mihai, Dorobanțu, Dan, Droc, Gabriela, Andrei, Ștefan, Știru, Ovidiu, Bubenek Turconi, Șerban-Ion, Filipescu, Daniela
• Format: Article
• Language: English
• Subjects: anaemia; Anemia; Anesthesia; Biological products; Blood products; Blood transfusion; Blood transfusions; Cardiac patients; cardiac surgery; Clinical outcomes; Data collection; Heart surgery; Hemoglobin; Hospitals; Medical research; Medicine, Experimental; patient blood management; Patient outcomes; Patients; Surgery; Surgical clinics; Tranexamic acid; transfusion; Variables
• ISSN: 2308-3425; 2308-3425
• DOI: 10.3390/jcdd10070266

The implementation of Patient Blood Management (PBM) in cardiac surgery has been shown to be effective in reducing blood transfusions and associated complications, as well as improving patient outcomes. Despite the potential benefits of PBM in cardiac surgery, there are several barriers to its successful implementation. The main objectives of this study were to ascertain the impact of the national Romanian PBM recommendations on allogeneic blood product transfusion in cardiac surgery and identify predictors of perioperative packed red blood cell transfusion. As part of the Romanian national pilot programme of PBM, we performed a single-centre, retrospective study in a tertiary centre of cardiovascular surgery, including patients from two time periods, before and after the implementation of the national recommendations. Using coarsened exact matching, from a total of 1174 patients, 157 patients from the before group were matched to 169 patients in the after group. Finally, we built a multivariate regression model from the entire cohort to analyse independent predictors of PRBC transfusion in the perioperative period. Although there was a trend towards a lower proportion of patients requiring PRBC transfusion in the "after" group compared to the "before" group (44.9%vs. 50.3%), it was not statistically significant. There was a significant difference between the "after" group and the "before" group in terms of fresh-frozen plasma (FFP) transfusion rates, with a lower percentage of patients requiring FFP transfusion in the "after" group compared to "before" (14.2%, vs. 22.9%, = 0.04). This difference was also seen in the total perioperative FFP transfusion (mean transfusion 0.7 units in the "before" group, SD 1.73 vs. 0.38 units in the "after" group, SD 1.05, = 0.04). In the multivariate regression analysis, age > 64 years (OR 1.652, 95% CI 1.17-2.331, = 0.004), female sex (OR 2.404, 95% CI 1.655-3.492, < 0.001), surgery time (OR 1.295, 95% CI 1.126-1.488, < 0.001), Hb < 13 g/dl (OR 3.611, 95% CI 2.528-5.158, < 0.001), re-exploration for bleeding (OR 3.988, 95% CI 1.248-12.738, = 0.020), viscoelastic test use (OR 2.18, 95% CI 1.34-3.544, < 0.001), FFP transfusion (OR 4.023, 95% CI 2.426-6.671, < 0.001), and use of a standardized pretransfusion checklist (OR 8.875, 95% CI 5.496-14.332, < 0.001) remained significantly associated with PRBC transfusion. The use of a preoperative standardized haemostasis questionnaire was independently associated with a decreased r