Kostenreduktion im Krankenhaus – Transfusionswesen: Kann die Behandlung der präoperativen Anämie Kosten reduzieren?

Zusammenfassung

Die präoperative Anämie ist ein unabhängiger Risikofaktor in der operativen Medizin. Die präoperative Anämie ist mit höheren Behandlungskosten verbunden und der Hauptrisikofaktor für die Gabe von Bluttransfusionen. Die Transfusion von Erythrozytenkonzentraten ist, wenn auch bei akuter Anämie lebensrettend, in der operative Medizin ebenfalls mit erhöhter Mortalität, Morbidität und Komplikationen nach Operationen assoziiert. Für die präoperative Behandlung der Anämie wurden eine Verbesserung des postoperativen Outcome der Patienten und ein reduzierter Transfusionsbedarf gezeigt. Die Anämiebehandlung als eine Säule des Patient-Blood-Management hat durch Reduktion von Komplikationen und transfusionsassoziierter Morbidität das Potential, Kosten im Gesundheitswesen zu senken. Das ökonomische Potential der präoperativen Anämiebehandlung gegenüber den Kosten der Transfusion von Blutprodukten muss in prospektiven Studien untersucht werden.

Abstract

Preoprative Anaemia is an independent risk factor in perioperative medicine. Furthermore, preoperative anaemia is associated with higher treatment costs and remains the main risk factor for the transfusion of packed red blood cells. However, transfusion of packed red blood cells is although life-saving in conditions of acute anaemia associated with higher mortality, morbidity and postoperative complications. The preoperative treatment of anaemia has been shown to improve postoperative outcome and transfusion requirements. Treatment of anemia as one pillar of patient blood management bears the potential to reduce costs to the national health system by prevention of complications and transfusion-associated morbidity. The economic impact of the treatment of preoperative anaemia versus the treatment with blood products requires prospective evaluation.

Kernaussagen

• Die WHO definiert die Kriterien einer Anämie wie folgt:

  • Hb-Wert bei Männern < 13 g/dl

  • Hb-Wert bei nicht schwangeren Frauen < 12 g/dl

• Die präoperative Anämie ist ein signifikanter Risikofaktor für den postoperativen Heilungsverlauf und das Überleben der Patienten. Sie ist mit hohen Behandlungskosten verbunden und gilt als Hauptrisikofaktor für die Gabe von Bluttransfusionen.

• In den nächsten 20 Jahren wird Prognosen zufolge immer weniger Blut gespendet – der Bedarf an Erythrozytenkonzentraten wird hingegen steigen.

• Bluttransfusionen sind mit erhöhter postoperativer Mortalität, Morbidität und Komplikationen assoziiert.

• Die Behandlung der präoperativen Anämie ist nicht nur aus medizinischer, sondern auch aus betriebswirtschaftlicher Sicht sinnvoll, da somit Bluttransfusionen verhindert und Kosten sowie Komplikationen reduziert werden können.

Schlüsselwörter:

Anämie - präoperativ - Operation - Mortalität - Bluttransfusion

Keywords:

blood transfusion - anaemia - preoperative - mortality - surgery

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