Impact of a blood conservation program on 30-day morbidity and mortality: a cohort study

• Published in: The Journal of surgical research 2014-03, Vol.187 (1), p.343-349
• Main Authors: Ramanan, Bala, MBBS, Burns, Tammy L., PharmD, Sugimoto, Jeffrey T., MD, Forse, Robert Armour, MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Blood conservation; Blood Loss, Surgical - mortality; Blood Loss, Surgical - prevention & control; Bloodless Medical and Surgical Procedures - methods; Bloodless Medical and Surgical Procedures - mortality; Cohort Studies; Databases, Factual; Female; Humans; Logistic Models; Male; Middle Aged; Morbidity; NSQIP; Postoperative Complications - mortality; Postoperative Complications - prevention & control; Quality Improvement; Risk Factors; Surgery; Surgical outcomes; Treatment Outcome; Treatment Refusal
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2013.10.005

Abstract Background There are little published data on outcomes of blood conservation (BC) patients after noncardiac surgery. The objective of this study was to compare the surgical outcomes of patients enrolled in our BC program with that of the general population of surgical patients. Methods BC patients at our institution undergoing various surgical procedures were identified from the 2007–2009 National Surgical Quality Improvement Program database and compared with a cohort of conventional care (CC) patients matched by age, gender, and surgical procedure. Univariate and multiple logistic regression analyses were performed to evaluate 30-d postoperative outcomes. Results One hundred twenty BC patients were compared with 238 CC patients. The two groups were similar for all preoperative variables except smoking, which was lower in the BC group. On univariate analysis, BC patients had similar mean operating time (148 versus 155 min; P  = 0.5), length of stay (5.9 versus 5.5 d; P  = 0.7), and rate of return to the operating room (7.5% versus 5.5%; P  = 0.4) compared with CC patients. BC and CC patients had similar 30-d morbidity (18% versus 14%; P  = 0.3) and mortality rates (1.6% versus 1.3%; P  = 1.0), respectively. On multivariable analysis, enrollment in the BC program had no impact on postoperative 30-d morbidity (odds ratio, 1.78; 95% confidence interval, 0.71–4.47) or 30-d mortality (unadjusted odds ratio, 1.33; 95% confidence interval, 0.22–8.05). Conclusions Short-term postoperative outcomes in BC patients are similar to the general population, and these patients should not be denied surgical treatment based on their unwillingness to receive blood products.