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Improvements in patient blood management for pediatric craniosynostosis surgery using a ROTEM®-assisted strategy – feasibility and costs
BACKGROUND: Moderate to severe intraoperative bleeding and the presence of acquired coagulopathy remain serious problems in the management of major pediatric craniosynostosis surgery. After implementation of a ROTEM®-assisted patient blood management (PBM) strategy, using primarily purified coagulat...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Blackwell Publishing Ltd
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4207194/ https://www.ncbi.nlm.nih.gov/pubmed/24417649 http://dx.doi.org/10.1111/pan.12341 |
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author | Haas, Thorsten Goobie, Susan Spielmann, Nelly Weiss, Markus Schmugge, Markus |
author_facet | Haas, Thorsten Goobie, Susan Spielmann, Nelly Weiss, Markus Schmugge, Markus |
author_sort | Haas, Thorsten |
collection | PubMed |
description | BACKGROUND: Moderate to severe intraoperative bleeding and the presence of acquired coagulopathy remain serious problems in the management of major pediatric craniosynostosis surgery. After implementation of a ROTEM®-assisted patient blood management (PBM) strategy, using primarily purified coagulation factor concentrates, feasibility and costs of this new regimen were analyzed. METHODS: Retrospective analysis of all consecutive children who underwent primary elective major craniofacial surgery for craniosynostosis repair was carried out at the Children's University Hospital, Zurich, between 2007 and 2013. Laboratory workup and transfusion requirements were compared. RESULTS: A total of 47 children (36 in the historic group and 11 after implementation of PBM) were analyzed. Although all patients in this study needed transfusion of red blood cell concentrates, there was a total avoidance of perioperative transfusion of fresh frozen plasma and a reduction in transfused platelets (one of nine children vs nine of 36 children in the historic group) after implementation of the PBM strategy. Based on a predefined ROTEM® threshold in the PBM group (FibTEM MCF <8 mm), administration of fibrinogen concentrate was necessary in all of these children. The mean total costs per patient consisting of transfused allogeneic blood products and coagulation factor concentrates were reduced by 17.1% after implementation of PBM (1071.82 EUR per patient before vs 888.93 EUR after implementation). CONCLUSIONS: The implementation of a ROTEM®-assisted PBM is feasible and is associated with a considerable reduction in intraoperative transfusion requirements and thereby a decrease in transfusion-related direct costs. |
format | Online Article Text |
id | pubmed-4207194 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Blackwell Publishing Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-42071942014-11-13 Improvements in patient blood management for pediatric craniosynostosis surgery using a ROTEM®-assisted strategy – feasibility and costs Haas, Thorsten Goobie, Susan Spielmann, Nelly Weiss, Markus Schmugge, Markus Paediatr Anaesth Original Articles BACKGROUND: Moderate to severe intraoperative bleeding and the presence of acquired coagulopathy remain serious problems in the management of major pediatric craniosynostosis surgery. After implementation of a ROTEM®-assisted patient blood management (PBM) strategy, using primarily purified coagulation factor concentrates, feasibility and costs of this new regimen were analyzed. METHODS: Retrospective analysis of all consecutive children who underwent primary elective major craniofacial surgery for craniosynostosis repair was carried out at the Children's University Hospital, Zurich, between 2007 and 2013. Laboratory workup and transfusion requirements were compared. RESULTS: A total of 47 children (36 in the historic group and 11 after implementation of PBM) were analyzed. Although all patients in this study needed transfusion of red blood cell concentrates, there was a total avoidance of perioperative transfusion of fresh frozen plasma and a reduction in transfused platelets (one of nine children vs nine of 36 children in the historic group) after implementation of the PBM strategy. Based on a predefined ROTEM® threshold in the PBM group (FibTEM MCF <8 mm), administration of fibrinogen concentrate was necessary in all of these children. The mean total costs per patient consisting of transfused allogeneic blood products and coagulation factor concentrates were reduced by 17.1% after implementation of PBM (1071.82 EUR per patient before vs 888.93 EUR after implementation). CONCLUSIONS: The implementation of a ROTEM®-assisted PBM is feasible and is associated with a considerable reduction in intraoperative transfusion requirements and thereby a decrease in transfusion-related direct costs. Blackwell Publishing Ltd 2014-07 2014-01-13 /pmc/articles/PMC4207194/ /pubmed/24417649 http://dx.doi.org/10.1111/pan.12341 Text en Copyright © 2014 The Authors. Pediatric Anesthesia Published by John Wiley & Sons Ltd http://creativecommons.org/licenses/by-nc-nd/3.0/ This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. |
spellingShingle | Original Articles Haas, Thorsten Goobie, Susan Spielmann, Nelly Weiss, Markus Schmugge, Markus Improvements in patient blood management for pediatric craniosynostosis surgery using a ROTEM®-assisted strategy – feasibility and costs |
title | Improvements in patient blood management for pediatric craniosynostosis surgery using
a ROTEM®-assisted strategy – feasibility and costs |
title_full | Improvements in patient blood management for pediatric craniosynostosis surgery using
a ROTEM®-assisted strategy – feasibility and costs |
title_fullStr | Improvements in patient blood management for pediatric craniosynostosis surgery using
a ROTEM®-assisted strategy – feasibility and costs |
title_full_unstemmed | Improvements in patient blood management for pediatric craniosynostosis surgery using
a ROTEM®-assisted strategy – feasibility and costs |
title_short | Improvements in patient blood management for pediatric craniosynostosis surgery using
a ROTEM®-assisted strategy – feasibility and costs |
title_sort | improvements in patient blood management for pediatric craniosynostosis surgery using
a rotem®-assisted strategy – feasibility and costs |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4207194/ https://www.ncbi.nlm.nih.gov/pubmed/24417649 http://dx.doi.org/10.1111/pan.12341 |
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