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Epidural/Echo/Coagulation

Autologous blood donation in cardiac surgery: a cost-effective method to reduce allogeneic blood requirements: 001

Dietrich, W.; Thuermel, K.

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European Journal of Anaesthesiology: June 2004 - Volume 21 - Issue - p 35

Introduction: Predonation of autologous blood is an effective method to reduce allogeneic blood transfusion in open-heart surgery [1]. However, the cost effectiveness of this method has been questioned [2]. The aim of the present study was to evaluate the influence of autologous pre-donation on transfusion requirements and to investigate the cost-effectiveness of this method from the hospital perspective.

Method: With institutional approval 4878 consecutive patients undergoing different open-heart procedures between 1995 and 2000 were retrospectively investigated. Data were prospectively collected in the department database. Pre-donation was performed within the hospital by anaesthesiologists familiar with the type of the planned operative procedure. A decision tree model was developed to analyse the propensity of receiving allogeneic blood transfusions. Patients were stratified for gender, preoperative risk, and type of operation. A transfusion trigger of 80-90 g/L was used in haemodynamically stable patients. Costs associated with blood transfusion as well as transfusion-related data were recorded. The endpoint was the number of autologous units necessary to avoid the transfusion of one unit of allogeneic blood and the costs associated with autologous pre-donation. Unpaired t-test and Chi-square test were used to compare patients with and without pre-donation.

Results:

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Table:
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The difference in transfusion requirement remained significant even after adjustment for preoperative risk. The donation of 1, 2 or 3 autologous units reduced the transfusion frequency to 24%, 14%, or 9%, respectively. It was estimated that with the donation of 1.5 units autologous blood the transfusion of one allogeneic unit was avoided. The additional transfusion cost, calculated from the hospital perspective, were 19 € (£13) per patient. Female patients donating 2 units produced equal transfusion costs compared to female patients without pre-donation with a significant reduction in allogeneic blood transfusions (22% transfused vs. 68%; P < 0.05). On the other hand, pre-donation in patients with ASD closure was not cost-effective.

Discussion: Autologous blood donation is a very effective method to reduce allogeneic blood transfusion in cardiac surgery. With appropriate organization, pre-donation is cost-effective even from the hospital perspective. Decision tree analysis enables tailoring a pre-donation programme according to the specific needs of a department.

References:

1 Dietrich W, Luth JU, Kormann J, et al. [Intraoperative blood requirements and allogeneic blood transfusion in cardioanesthesia surgery. Data analysis of 7729 patients in 12 cardiac surgical clinics.] Anaesthesist 1999; 48: 876-883. German.
2 Etchason J, Petz L, Keeler E, et al. The cost effectiveness of preoperative autologous blood donations. N Engl J Med 1995; 332: 719-724.
© 2004 European Society of Anaesthesiology