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

Introduction: 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 barrier...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10380242/
https://www.ncbi.nlm.nih.gov/pubmed/37504522
http://dx.doi.org/10.3390/jcdd10070266
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author 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
author_facet 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
author_sort Ștefan, Mihai
collection PubMed
description Introduction: 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. Objectives: 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. Methods: 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. Results: 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%, p = 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, p = 0.04). In the multivariate regression analysis, age > 64 years (OR 1.652, 95% CI 1.17–2.331, p = 0.004), female sex (OR 2.404, 95% CI 1.655–3.492, p < 0.001), surgery time (OR 1.295, 95% CI 1.126–1.488, p < 0.001), Hb < 13 g/dl (OR 3.611, 95% CI 2.528–5.158, p < 0.001), re-exploration for bleeding (OR 3.988, 95% CI 1.248–12.738, p = 0.020), viscoelastic test use (OR 2.18, 95% CI 1.34–3.544, p < 0.001), FFP transfusion (OR 4.023, 95% CI 2.426–6.671, p < 0.001), and use of a standardized pretransfusion checklist (OR 8.875, 95% CI 5.496–14.332, p < 0.001) remained significantly associated with PRBC transfusion. The use of a preoperative standardized haemostasis questionnaire was independently associated with a decreased risk of perioperative PRBC transfusion (0.565, 95% CI 0.371–0.861, p = 0.008). Conclusions: Implementation of national PBM recommendations led to a reduction in FFP transfusion in a cardiac surgery centre. The use of a preoperative standardized haemostasis questionnaire is an independent predictor of a lower risk for PRBC transfusion in this setting.
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spelling pubmed-103802422023-07-29 Less (Transfusion) Is More—Enhancing Recovery through Implementation of Patient Blood Management in Cardiac Surgery: A Retrospective, Single-Centre Study of 1174 Patients 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 J Cardiovasc Dev Dis Article Introduction: 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. Objectives: 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. Methods: 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. Results: 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%, p = 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, p = 0.04). In the multivariate regression analysis, age > 64 years (OR 1.652, 95% CI 1.17–2.331, p = 0.004), female sex (OR 2.404, 95% CI 1.655–3.492, p < 0.001), surgery time (OR 1.295, 95% CI 1.126–1.488, p < 0.001), Hb < 13 g/dl (OR 3.611, 95% CI 2.528–5.158, p < 0.001), re-exploration for bleeding (OR 3.988, 95% CI 1.248–12.738, p = 0.020), viscoelastic test use (OR 2.18, 95% CI 1.34–3.544, p < 0.001), FFP transfusion (OR 4.023, 95% CI 2.426–6.671, p < 0.001), and use of a standardized pretransfusion checklist (OR 8.875, 95% CI 5.496–14.332, p < 0.001) remained significantly associated with PRBC transfusion. The use of a preoperative standardized haemostasis questionnaire was independently associated with a decreased risk of perioperative PRBC transfusion (0.565, 95% CI 0.371–0.861, p = 0.008). Conclusions: Implementation of national PBM recommendations led to a reduction in FFP transfusion in a cardiac surgery centre. The use of a preoperative standardized haemostasis questionnaire is an independent predictor of a lower risk for PRBC transfusion in this setting. MDPI 2023-06-22 /pmc/articles/PMC10380242/ /pubmed/37504522 http://dx.doi.org/10.3390/jcdd10070266 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
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
Less (Transfusion) Is More—Enhancing Recovery through Implementation of Patient Blood Management in Cardiac Surgery: A Retrospective, Single-Centre Study of 1174 Patients
title Less (Transfusion) Is More—Enhancing Recovery through Implementation of Patient Blood Management in Cardiac Surgery: A Retrospective, Single-Centre Study of 1174 Patients
title_full Less (Transfusion) Is More—Enhancing Recovery through Implementation of Patient Blood Management in Cardiac Surgery: A Retrospective, Single-Centre Study of 1174 Patients
title_fullStr Less (Transfusion) Is More—Enhancing Recovery through Implementation of Patient Blood Management in Cardiac Surgery: A Retrospective, Single-Centre Study of 1174 Patients
title_full_unstemmed Less (Transfusion) Is More—Enhancing Recovery through Implementation of Patient Blood Management in Cardiac Surgery: A Retrospective, Single-Centre Study of 1174 Patients
title_short Less (Transfusion) Is More—Enhancing Recovery through Implementation of Patient Blood Management in Cardiac Surgery: A Retrospective, Single-Centre Study of 1174 Patients
title_sort less (transfusion) is more—enhancing recovery through implementation of patient blood management in cardiac surgery: a retrospective, single-centre study of 1174 patients
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10380242/
https://www.ncbi.nlm.nih.gov/pubmed/37504522
http://dx.doi.org/10.3390/jcdd10070266
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