Cost Analysis of Transfusion Therapy in Coronary Artery Surgery

Mirna Petricevic; Mate Petricevic; Marijan Pasalic; Branka Golubic Cepulic; Mirela Raos; Dora Dujmic; Viktor Kalamar; Vice Mestrovic; Hrvoje Gasparovic; Vesna Vasicek; Klaus Goerlinger; Bojan Biocina

doi:10.1055/s-0039-1697600

The Thoracic and Cardiovascular Surgeon, Table of Contents

Thorac Cardiovasc Surg 2021; 69(07): 621-629
DOI: 10.1055/s-0039-1697600

Original Cardiovascular

Cost Analysis of Transfusion Therapy in Coronary Artery Surgery

Mirna Petricevic‡^*

¹University of Split School of Medicine, Split, Croatia

,

Mate Petricevic^*

²Department of Cardiac Surgery, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia

,

Marijan Pasalic

³Department for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia

,

Branka Golubic Cepulic

⁴Clinical Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia

,

Mirela Raos

⁴Clinical Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia

,

Dora Dujmic

⁵Dora Dujmic, Lawrence University, Appleton, Wisconsin, United States

,

Viktor Kalamar

²Department of Cardiac Surgery, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia

,

Vice Mestrovic

⁶Andrija Stampar Teaching Institute of Public Health, Leadership and Management of Health Services, Zagreb, Croatia

,

Hrvoje Gasparovic

²Department of Cardiac Surgery, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia

,

Vesna Vasicek

⁷Accounting Department, Faculty of Economics and Business, University of Zagreb, Zagreb, Croatia

,

Klaus Goerlinger

⁸Klinik fur Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Universität Duisburg-Essen, and TEM International GmbH, Munich, Germany

,

Bojan Biocina

²Department of Cardiac Surgery, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia

› Author Affiliations

Abstract

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Abstract

Background In patients undergoing coronary artery bypass grafting (CABG), wide variability in transfusion rate (7.8% to 92.8%) raises the question of the amount of unnecessary transfusions. The aim of the study was (1) to identify CABG patients at low risk of bleeding to whom transfusion treatment should be avoided and (2) to calculate the amount of possible cost savings that would be achieved by avoiding transfusion in low bleeding risk patients.

Methods This retrospective observational study enrolled patients undergoing isolated elective CABG from January 2010 to January 2018. Patients were divided with respect to the presence of excessive bleeding and transfusion costs were compared between the two groups. Predictors for postoperative excessive bleeding were defined and multivariable logistic regression analysis and risk modeling were performed. The use of a model to predict patients at low risk of bleeding allowed for the estimation of transfusion cost savings assuming the patients who were found to be at low risk of bleeding should not be transfused.

Results A total of 1,426 patients were enrolled in the analysis. Of those, 28.3% had excessive postoperative bleeding. The multivariate logistic regression analysis model was developed to identify/predict patients without excessive bleeding (receiver operating characteristic curve analysis, area under the curve 72.3%, p < 0.001). When applied to the existing database, the use of the developed model identifying patients at low risk of bleeding may result in a 39.1% reduction of transfusions. Specifically, cost savings would be 48.2% for packed red blood cells, 38.9% for fresh frozen plasma, 10.9% for platelets concentrate, and 17.9% for fibrinogen concentrate.

Conclusion The clinical and economic burdens associated with unnecessary transfusions are significant. Avoiding transfusion in CABG patients found to be at low risk of bleeding may result in significant reduction of transfusion rate and transfusion-associated costs.

Keywords

coronary artery bypass grafting - surgery - complications - health economics - cost analysis - blood transfusion

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References

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