Ten-year patterns in blood product utilization during cardiothoracic surgery with cardiopulmonary bypass in a tertiary hospital

Authors

  • Alexander B.A. Vonk,

    1. Department of Cardio-thoracic Surgery, VU University Medical Center, Amsterdam, the Netherlands
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  • Michael I. Meesters,

    1. Department of Cardio-thoracic Surgery, VU University Medical Center, Amsterdam, the Netherlands
    2. Department of Anesthesiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands
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  • Wouter B. van Dijk,

    1. Department of Anesthesiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands
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  • Leon Eijsman,

    1. Department of Cardio-thoracic Surgery, VU University Medical Center, Amsterdam, the Netherlands
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  • Johannes W.A. Romijn,

    1. Department of Anesthesiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands
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  • Evert K. Jansen,

    1. Department of Cardio-thoracic Surgery, VU University Medical Center, Amsterdam, the Netherlands
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  • Stephan A. Loer,

    1. Department of Anesthesiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands
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  • Christa Boer

    Corresponding author
    1. Department of Anesthesiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands
    • Address correspondence to: Christa Boer, Department of Anesthesiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; e-mail: c.boer@vumc.nl.

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  • This work was supported by the Department of Cardio-thoracic Surgery, VU University Medical Center, Amsterdam, the Netherlands.

Abstract

Background

This retrospective analysis describes blood conservation strategies and overall consumption of red blood cells (RBCs), fresh-frozen plasma (FFP), and platelet (PLT) concentrates during nonaortic cardiac surgery with cardiopulmonary bypass (CPB) in a tertiary hospital over a 10-year period.

Study Design and Methods

Study variables of 6026 patients that underwent cardiac surgery between 2002 and 2011 were incorporated in the database and included hemoglobin (Hb), lowest temperature, CPB duration, 24-hour blood loss, fluid balance, and overall transfusion requirements.

Results

Between 2002 and 2011, the lowest intraoperative Hb levels and temperature increased from 8.5 ± 1.2 to 10.4 ± 1.4 g/dL and from 32 ± 2 to 34 ± 1°C, respectively. In addition to the steep decrease in the postoperative fluid balance over time, a reduction in 24-hour blood loss from 815 ± 588 mL (2002) to 590 ± 438 mL (2011) was observed. These changes were paralleled by a 28% reduction in overall RBC transfusion from 1443 units in 2002 to 1038 in 2011. While RBC transfusion decreased over time, there was no significant change in the use of FFP or PLT concentrate transfusion. The probability to receive RBC transfusion increased after cessation of aprotinin, but reduced after routine cell salvage in all operations.

Conclusion

This institutional report shows a large reduction in blood loss and transfusion requirements in cardiac surgery over a 10-year period. This reduction is most probably attributed to structural cell salvage, reduced intraoperative fluid volumes, and the increase in the lowest intraoperative body temperature.

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