Impact of patient blood management guidelines on blood transfusions and patient outcomes during cardiac surgery

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Abstract

Objective: In March 2012, Australia's National Blood Authority published national patient blood-management guidelines for perioperative care developed by a systematic review and clinical expert opinion. This study assesses how blood transfusions and patient outcomes in cardiac surgery changed after the guidelines were published. Methods: Blood transfusions and patient outcomes in cardiac surgery were compared before and after implementation of the guidelines using an interrupted time series analysis. The evaluation included red blood cells, platelets, cryoprecipitate, fresh-frozen plasma, 30-day mortality, 30-day readmissions, and hospital and intensive care length of stay. Patient characteristics were controlled for along with hospital characteristics using fixed effects. Different responses across institutional settings were assessed with an expanded difference-in-differences model. Results: After the guidelines were published, our model found a significant reduction in red blood cell, platelet, and fresh-frozen plasma transfusions. There was also a significant reduction in hospital length of stay but no significant impact on cryoprecipitate, 30-day mortality, 30-day readmissions, or intensive care unit length of stay. The subgroup analyses found no differences with regards to institutional settings. Conclusions: Following the publication of the guidelines, there was a measurable reduction in perioperative blood transfusions in cardiac surgery with an associated reduction in hospital length of stay but no detectable differences in other patient outcomes.

Original languageEnglish
Number of pages30
JournalJournal of Thoracic and Cardiovascular Surgery
DOIs
Publication statusAccepted/In press - 2019

Keywords

  • cardiac surgery
  • patient blood management

Cite this

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title = "Impact of patient blood management guidelines on blood transfusions and patient outcomes during cardiac surgery",
abstract = "Objective: In March 2012, Australia's National Blood Authority published national patient blood-management guidelines for perioperative care developed by a systematic review and clinical expert opinion. This study assesses how blood transfusions and patient outcomes in cardiac surgery changed after the guidelines were published. Methods: Blood transfusions and patient outcomes in cardiac surgery were compared before and after implementation of the guidelines using an interrupted time series analysis. The evaluation included red blood cells, platelets, cryoprecipitate, fresh-frozen plasma, 30-day mortality, 30-day readmissions, and hospital and intensive care length of stay. Patient characteristics were controlled for along with hospital characteristics using fixed effects. Different responses across institutional settings were assessed with an expanded difference-in-differences model. Results: After the guidelines were published, our model found a significant reduction in red blood cell, platelet, and fresh-frozen plasma transfusions. There was also a significant reduction in hospital length of stay but no significant impact on cryoprecipitate, 30-day mortality, 30-day readmissions, or intensive care unit length of stay. The subgroup analyses found no differences with regards to institutional settings. Conclusions: Following the publication of the guidelines, there was a measurable reduction in perioperative blood transfusions in cardiac surgery with an associated reduction in hospital length of stay but no detectable differences in other patient outcomes.",
keywords = "cardiac surgery, patient blood management",
author = "Irving, {Adam H.} and Anthony Harris and Dennis Petrie and Alisa Higgins and Julian Smith and McQuilten, {Zoe K.}",
year = "2019",
doi = "10.1016/j.jtcvs.2019.08.102",
language = "English",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
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T1 - Impact of patient blood management guidelines on blood transfusions and patient outcomes during cardiac surgery

AU - Irving, Adam H.

AU - Harris, Anthony

AU - Petrie, Dennis

AU - Higgins, Alisa

AU - Smith, Julian

AU - McQuilten, Zoe K.

PY - 2019

Y1 - 2019

N2 - Objective: In March 2012, Australia's National Blood Authority published national patient blood-management guidelines for perioperative care developed by a systematic review and clinical expert opinion. This study assesses how blood transfusions and patient outcomes in cardiac surgery changed after the guidelines were published. Methods: Blood transfusions and patient outcomes in cardiac surgery were compared before and after implementation of the guidelines using an interrupted time series analysis. The evaluation included red blood cells, platelets, cryoprecipitate, fresh-frozen plasma, 30-day mortality, 30-day readmissions, and hospital and intensive care length of stay. Patient characteristics were controlled for along with hospital characteristics using fixed effects. Different responses across institutional settings were assessed with an expanded difference-in-differences model. Results: After the guidelines were published, our model found a significant reduction in red blood cell, platelet, and fresh-frozen plasma transfusions. There was also a significant reduction in hospital length of stay but no significant impact on cryoprecipitate, 30-day mortality, 30-day readmissions, or intensive care unit length of stay. The subgroup analyses found no differences with regards to institutional settings. Conclusions: Following the publication of the guidelines, there was a measurable reduction in perioperative blood transfusions in cardiac surgery with an associated reduction in hospital length of stay but no detectable differences in other patient outcomes.

AB - Objective: In March 2012, Australia's National Blood Authority published national patient blood-management guidelines for perioperative care developed by a systematic review and clinical expert opinion. This study assesses how blood transfusions and patient outcomes in cardiac surgery changed after the guidelines were published. Methods: Blood transfusions and patient outcomes in cardiac surgery were compared before and after implementation of the guidelines using an interrupted time series analysis. The evaluation included red blood cells, platelets, cryoprecipitate, fresh-frozen plasma, 30-day mortality, 30-day readmissions, and hospital and intensive care length of stay. Patient characteristics were controlled for along with hospital characteristics using fixed effects. Different responses across institutional settings were assessed with an expanded difference-in-differences model. Results: After the guidelines were published, our model found a significant reduction in red blood cell, platelet, and fresh-frozen plasma transfusions. There was also a significant reduction in hospital length of stay but no significant impact on cryoprecipitate, 30-day mortality, 30-day readmissions, or intensive care unit length of stay. The subgroup analyses found no differences with regards to institutional settings. Conclusions: Following the publication of the guidelines, there was a measurable reduction in perioperative blood transfusions in cardiac surgery with an associated reduction in hospital length of stay but no detectable differences in other patient outcomes.

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KW - patient blood management

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