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Retrospective analysis of autologous blood use in bimaxillary repositioning osteotomy surgery: a quality improvement study
BACKGROUND: Multiple studies have considered the necessity of preoperative autologous blood donation before bimaxillary orthognathic osteotomies. In the context of a quality improvement project, this topic was also investigated in our institution. Furthermore, the transfusion practice was analyzed a...
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| Published in: | Transfusion (Philadelphia, Pa.) Pa.), 2009-08, Vol.49 (8), p.1747-1753 |
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| container_title | Transfusion (Philadelphia, Pa.) |
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| creator | Böttger, Sebastian Streckbein, Philipp Hartmann, Bernd Schaaf, Heidrun Howaldt, Hans Peter Junger, Axel |
| description | BACKGROUND: Multiple studies have considered the necessity of preoperative autologous blood donation before bimaxillary orthognathic osteotomies. In the context of a quality improvement project, this topic was also investigated in our institution. Furthermore, the transfusion practice was analyzed and the correlations between patient, operative variables, and blood loss were studied.
STUDY DESIGN AND METHODS: In accordance with the recommendations of the Federal Medical Association and the Federal Ministry for Health and Social Security, a transfusion demand list was compiled using data of 82 patients who underwent bimaxillary orthognathic surgery between 1997 and 2005. The maximum blood loss tolerable without transfusion (MBL) was calculated for each patient on the basis of sex, weight, height, and preoperative hematocrit (Hct). This was compared with the actual transfusion and blood loss data.
RESULTS: An autologous blood donation was carried out in 65 of 82 patients (79.3%). Sixty‐two of 65 autologous blood donors (95.4%) and 2 of 17 patients (11.8%) without autologous blood donation received transfusion. The actual blood loss did not exceed the calculated MBL in 48 of the 82 cases. Nevertheless, 31 of these 48 patients (64.6%) received transfusions. For patients with a low calculated MBL, only a trend to a higher transfusion rate was observed, although the actual blood loss in these cases more often exceeded the individually calculated MBL (p |
| doi_str_mv | 10.1111/j.1537-2995.2009.02169.x |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_860395912</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>860395912</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4679-a548ec667b0e54e3f3be7a99ef720448aabdc305990796ab808518efa266ea493</originalsourceid><addsrcrecordid>eNqNkc2O0zAURi0EYsrAKyBvgFWCf5LYRmKBBqZQjQapGsTSctKbyiWJO7YzNDw9Dq3KDuGNLfl8vtf3IIQpyWlab3c5LbnImFJlzghROWG0UvnhEVqcLx6jBSEFzSjl7AI9C2FHCGGK0KfogiqumBDFAv1aQ_Qu7KGJ9gGwGUw3BRuwa7EZo-vc1o0B151zGzwGwHbAte3NwXad8RP2sHfBRusGO2yxCxFcdP2Ew-i34Kd32OD70XQ2Ttj2e-8eoIch4hDHzfQcPWlNF-DFab9E364_3V19zm6-Lr9cfbjJmqISKjNlIaGpKlETKAvgLa9BGKWgFYwUhTSm3jSclEoRoSpTSyJLKqE1rKrAFIpfojfHd1P9-xFC1L0NDaQPDJA-p2VFuCoVZYl8_U-SESnT5IoEyiPYpNkFD63e-zQVP2lK9GxI7_QsQs8i9GxI_zGkDyn68lRjrHvY_A2elCTg1QkwoTFd683Q2HDmGJWcMDE3-_7I_bQdTP_dgL5bX8-nlM-OeZusHc5543_oSnBR6u-3S73-eMvUarXSS_4bl2G-xQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>20889394</pqid></control><display><type>article</type><title>Retrospective analysis of autologous blood use in bimaxillary repositioning osteotomy surgery: a quality improvement study</title><source>Wiley-Blackwell Read & Publish Collection</source><creator>Böttger, Sebastian ; Streckbein, Philipp ; Hartmann, Bernd ; Schaaf, Heidrun ; Howaldt, Hans Peter ; Junger, Axel</creator><creatorcontrib>Böttger, Sebastian ; Streckbein, Philipp ; Hartmann, Bernd ; Schaaf, Heidrun ; Howaldt, Hans Peter ; Junger, Axel</creatorcontrib><description>BACKGROUND: Multiple studies have considered the necessity of preoperative autologous blood donation before bimaxillary orthognathic osteotomies. In the context of a quality improvement project, this topic was also investigated in our institution. Furthermore, the transfusion practice was analyzed and the correlations between patient, operative variables, and blood loss were studied.
STUDY DESIGN AND METHODS: In accordance with the recommendations of the Federal Medical Association and the Federal Ministry for Health and Social Security, a transfusion demand list was compiled using data of 82 patients who underwent bimaxillary orthognathic surgery between 1997 and 2005. The maximum blood loss tolerable without transfusion (MBL) was calculated for each patient on the basis of sex, weight, height, and preoperative hematocrit (Hct). This was compared with the actual transfusion and blood loss data.
RESULTS: An autologous blood donation was carried out in 65 of 82 patients (79.3%). Sixty‐two of 65 autologous blood donors (95.4%) and 2 of 17 patients (11.8%) without autologous blood donation received transfusion. The actual blood loss did not exceed the calculated MBL in 48 of the 82 cases. Nevertheless, 31 of these 48 patients (64.6%) received transfusions. For patients with a low calculated MBL, only a trend to a higher transfusion rate was observed, although the actual blood loss in these cases more often exceeded the individually calculated MBL (p < 0.01). In addition, transfusion triggers (Hct ≤0.22 or hemoglobin ≤7.5 g/dL) were also more often seen in cases with low calculated MBL (p < 0.05).
CONCLUSIONS: In this study, an inappropriate transfusion practice in patients undergoing bimaxillary orthognathic osteotomies after preoperative autologous blood donation was detected. Calculation of the individual MBL should be used to help identify patients at high risk for transfusion and guide adequate methods to decrease the need of homologous blood.</description><identifier>ISSN: 0041-1132</identifier><identifier>EISSN: 1537-2995</identifier><identifier>DOI: 10.1111/j.1537-2995.2009.02169.x</identifier><identifier>PMID: 19392774</identifier><identifier>CODEN: TRANAT</identifier><language>eng</language><publisher>Malden, USA: Blackwell Publishing Inc</publisher><subject>Adolescent ; Adult ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Blood Donors ; Blood Loss, Surgical - prevention & control ; Blood Transfusion, Autologous - methods ; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis ; Body Weight ; Female ; Germany ; Hematocrit ; Humans ; Male ; Medical sciences ; Middle Aged ; Orthognathic Surgical Procedures ; Quality Control ; Retrospective Studies ; Sex Factors ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the heart ; Transfusions. Complications. Transfusion reactions. Cell and gene therapy</subject><ispartof>Transfusion (Philadelphia, Pa.), 2009-08, Vol.49 (8), p.1747-1753</ispartof><rights>2009 American Association of Blood Banks</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4679-a548ec667b0e54e3f3be7a99ef720448aabdc305990796ab808518efa266ea493</citedby><cites>FETCH-LOGICAL-c4679-a548ec667b0e54e3f3be7a99ef720448aabdc305990796ab808518efa266ea493</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27922,27923</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21830272$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19392774$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Böttger, Sebastian</creatorcontrib><creatorcontrib>Streckbein, Philipp</creatorcontrib><creatorcontrib>Hartmann, Bernd</creatorcontrib><creatorcontrib>Schaaf, Heidrun</creatorcontrib><creatorcontrib>Howaldt, Hans Peter</creatorcontrib><creatorcontrib>Junger, Axel</creatorcontrib><title>Retrospective analysis of autologous blood use in bimaxillary repositioning osteotomy surgery: a quality improvement study</title><title>Transfusion (Philadelphia, Pa.)</title><addtitle>Transfusion</addtitle><description>BACKGROUND: Multiple studies have considered the necessity of preoperative autologous blood donation before bimaxillary orthognathic osteotomies. In the context of a quality improvement project, this topic was also investigated in our institution. Furthermore, the transfusion practice was analyzed and the correlations between patient, operative variables, and blood loss were studied.
STUDY DESIGN AND METHODS: In accordance with the recommendations of the Federal Medical Association and the Federal Ministry for Health and Social Security, a transfusion demand list was compiled using data of 82 patients who underwent bimaxillary orthognathic surgery between 1997 and 2005. The maximum blood loss tolerable without transfusion (MBL) was calculated for each patient on the basis of sex, weight, height, and preoperative hematocrit (Hct). This was compared with the actual transfusion and blood loss data.
RESULTS: An autologous blood donation was carried out in 65 of 82 patients (79.3%). Sixty‐two of 65 autologous blood donors (95.4%) and 2 of 17 patients (11.8%) without autologous blood donation received transfusion. The actual blood loss did not exceed the calculated MBL in 48 of the 82 cases. Nevertheless, 31 of these 48 patients (64.6%) received transfusions. For patients with a low calculated MBL, only a trend to a higher transfusion rate was observed, although the actual blood loss in these cases more often exceeded the individually calculated MBL (p < 0.01). In addition, transfusion triggers (Hct ≤0.22 or hemoglobin ≤7.5 g/dL) were also more often seen in cases with low calculated MBL (p < 0.05).
CONCLUSIONS: In this study, an inappropriate transfusion practice in patients undergoing bimaxillary orthognathic osteotomies after preoperative autologous blood donation was detected. Calculation of the individual MBL should be used to help identify patients at high risk for transfusion and guide adequate methods to decrease the need of homologous blood.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Blood Donors</subject><subject>Blood Loss, Surgical - prevention & control</subject><subject>Blood Transfusion, Autologous - methods</subject><subject>Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis</subject><subject>Body Weight</subject><subject>Female</subject><subject>Germany</subject><subject>Hematocrit</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Orthognathic Surgical Procedures</subject><subject>Quality Control</subject><subject>Retrospective Studies</subject><subject>Sex Factors</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the heart</subject><subject>Transfusions. Complications. Transfusion reactions. Cell and gene therapy</subject><issn>0041-1132</issn><issn>1537-2995</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><recordid>eNqNkc2O0zAURi0EYsrAKyBvgFWCf5LYRmKBBqZQjQapGsTSctKbyiWJO7YzNDw9Dq3KDuGNLfl8vtf3IIQpyWlab3c5LbnImFJlzghROWG0UvnhEVqcLx6jBSEFzSjl7AI9C2FHCGGK0KfogiqumBDFAv1aQ_Qu7KGJ9gGwGUw3BRuwa7EZo-vc1o0B151zGzwGwHbAte3NwXad8RP2sHfBRusGO2yxCxFcdP2Ew-i34Kd32OD70XQ2Ttj2e-8eoIch4hDHzfQcPWlNF-DFab9E364_3V19zm6-Lr9cfbjJmqISKjNlIaGpKlETKAvgLa9BGKWgFYwUhTSm3jSclEoRoSpTSyJLKqE1rKrAFIpfojfHd1P9-xFC1L0NDaQPDJA-p2VFuCoVZYl8_U-SESnT5IoEyiPYpNkFD63e-zQVP2lK9GxI7_QsQs8i9GxI_zGkDyn68lRjrHvY_A2elCTg1QkwoTFd683Q2HDmGJWcMDE3-_7I_bQdTP_dgL5bX8-nlM-OeZusHc5543_oSnBR6u-3S73-eMvUarXSS_4bl2G-xQ</recordid><startdate>200908</startdate><enddate>200908</enddate><creator>Böttger, Sebastian</creator><creator>Streckbein, Philipp</creator><creator>Hartmann, Bernd</creator><creator>Schaaf, Heidrun</creator><creator>Howaldt, Hans Peter</creator><creator>Junger, Axel</creator><general>Blackwell Publishing Inc</general><general>Wiley</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7U1</scope><scope>7U2</scope><scope>C1K</scope><scope>7X8</scope></search><sort><creationdate>200908</creationdate><title>Retrospective analysis of autologous blood use in bimaxillary repositioning osteotomy surgery: a quality improvement study</title><author>Böttger, Sebastian ; Streckbein, Philipp ; Hartmann, Bernd ; Schaaf, Heidrun ; Howaldt, Hans Peter ; Junger, Axel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4679-a548ec667b0e54e3f3be7a99ef720448aabdc305990796ab808518efa266ea493</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Blood Donors</topic><topic>Blood Loss, Surgical - prevention & control</topic><topic>Blood Transfusion, Autologous - methods</topic><topic>Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis</topic><topic>Body Weight</topic><topic>Female</topic><topic>Germany</topic><topic>Hematocrit</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Orthognathic Surgical Procedures</topic><topic>Quality Control</topic><topic>Retrospective Studies</topic><topic>Sex Factors</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the heart</topic><topic>Transfusions. Complications. Transfusion reactions. Cell and gene therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Böttger, Sebastian</creatorcontrib><creatorcontrib>Streckbein, Philipp</creatorcontrib><creatorcontrib>Hartmann, Bernd</creatorcontrib><creatorcontrib>Schaaf, Heidrun</creatorcontrib><creatorcontrib>Howaldt, Hans Peter</creatorcontrib><creatorcontrib>Junger, Axel</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Risk Abstracts</collection><collection>Safety Science and Risk</collection><collection>Environmental Sciences and Pollution Management</collection><collection>MEDLINE - Academic</collection><jtitle>Transfusion (Philadelphia, Pa.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Böttger, Sebastian</au><au>Streckbein, Philipp</au><au>Hartmann, Bernd</au><au>Schaaf, Heidrun</au><au>Howaldt, Hans Peter</au><au>Junger, Axel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Retrospective analysis of autologous blood use in bimaxillary repositioning osteotomy surgery: a quality improvement study</atitle><jtitle>Transfusion (Philadelphia, Pa.)</jtitle><addtitle>Transfusion</addtitle><date>2009-08</date><risdate>2009</risdate><volume>49</volume><issue>8</issue><spage>1747</spage><epage>1753</epage><pages>1747-1753</pages><issn>0041-1132</issn><eissn>1537-2995</eissn><coden>TRANAT</coden><abstract>BACKGROUND: Multiple studies have considered the necessity of preoperative autologous blood donation before bimaxillary orthognathic osteotomies. In the context of a quality improvement project, this topic was also investigated in our institution. Furthermore, the transfusion practice was analyzed and the correlations between patient, operative variables, and blood loss were studied.
STUDY DESIGN AND METHODS: In accordance with the recommendations of the Federal Medical Association and the Federal Ministry for Health and Social Security, a transfusion demand list was compiled using data of 82 patients who underwent bimaxillary orthognathic surgery between 1997 and 2005. The maximum blood loss tolerable without transfusion (MBL) was calculated for each patient on the basis of sex, weight, height, and preoperative hematocrit (Hct). This was compared with the actual transfusion and blood loss data.
RESULTS: An autologous blood donation was carried out in 65 of 82 patients (79.3%). Sixty‐two of 65 autologous blood donors (95.4%) and 2 of 17 patients (11.8%) without autologous blood donation received transfusion. The actual blood loss did not exceed the calculated MBL in 48 of the 82 cases. Nevertheless, 31 of these 48 patients (64.6%) received transfusions. For patients with a low calculated MBL, only a trend to a higher transfusion rate was observed, although the actual blood loss in these cases more often exceeded the individually calculated MBL (p < 0.01). In addition, transfusion triggers (Hct ≤0.22 or hemoglobin ≤7.5 g/dL) were also more often seen in cases with low calculated MBL (p < 0.05).
CONCLUSIONS: In this study, an inappropriate transfusion practice in patients undergoing bimaxillary orthognathic osteotomies after preoperative autologous blood donation was detected. Calculation of the individual MBL should be used to help identify patients at high risk for transfusion and guide adequate methods to decrease the need of homologous blood.</abstract><cop>Malden, USA</cop><pub>Blackwell Publishing Inc</pub><pmid>19392774</pmid><doi>10.1111/j.1537-2995.2009.02169.x</doi><tpages>7</tpages></addata></record> |
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| subjects | Adolescent Adult Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Blood Donors Blood Loss, Surgical - prevention & control Blood Transfusion, Autologous - methods Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis Body Weight Female Germany Hematocrit Humans Male Medical sciences Middle Aged Orthognathic Surgical Procedures Quality Control Retrospective Studies Sex Factors Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Transfusions. Complications. Transfusion reactions. Cell and gene therapy |
| title | Retrospective analysis of autologous blood use in bimaxillary repositioning osteotomy surgery: a quality improvement study |
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