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J Chest Surg

Published online April 8, 2024

Copyright © Journal of Chest Surgery.

Improvement of Transfusion Practice in Cardiothoracic Surgery Through Implementing a Patient Blood Management Program

Hee Jung Kim , M.D., Ph.D.1,*, Hyeon Ju Shin , M.D., Ph.D.2,*, Suk Woo Lee , M.D.2, Seonyeong Heo , M.D.1, Seung Hyong Lee , M.D.1, Ji Eon Kim , M.D.1, Ho Sung Son , M.D., Ph.D.1, Jae Seung Jung , M.D., Ph.D.1

Departments of 1Thoracic and Cardiovascular Surgery and 2Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea

Correspondence to:Jae Seung Jung
Tel 82-2-920-6400
E-mail heartistcs@korea.ac.kr
ORCID
https://orcid.org/0000-0002-8848-4112

*These authors contributed equally to this work as the first authors.

Received: November 9, 2023; Revised: January 15, 2024; Accepted: January 26, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: In this study, we examined the impact of a patient blood management (PBM) program on red blood cell (RBC) transfusion practices in cardiothoracic surgery.
Methods: The PBM program had 3 components: monitoring transfusions through an order communication system checklist, educating the medical team about PBM, and providing feedback to ordering physicians on the appropriateness of transfusion. The retrospective analysis examined changes in the hemoglobin levels triggering transfusion and the proportions of appropriate RBC transfusions before, during, and after PBM implementation. Further analysis was focused on patients undergoing cardiac surgery, with outcomes including 30-day mortality, durations of intensive care unit and hospital stays, and rates of pneumonia, sepsis, and wound complications.
Results: The study included 2,802 patients admitted for cardiothoracic surgery. After the implementation of PBM, a significant decrease was observed in the hemoglobin threshold for RBC transfusion. This threshold dropped from 8.7 g/dL before PBM to 8.3 g/dL during the PBM education phase and 8.0 g/dL during the PBM feedback period. Additionally, the proportion of appropriate RBC transfusions increased markedly, from 23.9% before PBM to 34.9% and 58.2% during the education and feedback phases, respectively. Among the 381 patients who underwent cardiac surgery, a significant reduction was noted in the length of hospitalization over time (p<0.001). However, other clinical outcomes displayed no significant differences.
Conclusion: PBM implementation effectively reduced the hemoglobin threshold for RBC transfusion and increased the rate of appropriate transfusion in cardiothoracic surgery. Although transfusion practices improved, clinical outcomes were comparable to those observed before PBM implementation.

Keywords: Patient blood management, Transfusion, Cardiothoracic surgery

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J Chest Surg

Published online April 8, 2024

Copyright © Journal of Chest Surgery.

Improvement of Transfusion Practice in Cardiothoracic Surgery Through Implementing a Patient Blood Management Program

Hee Jung Kim , M.D., Ph.D.1,*, Hyeon Ju Shin , M.D., Ph.D.2,*, Suk Woo Lee , M.D.2, Seonyeong Heo , M.D.1, Seung Hyong Lee , M.D.1, Ji Eon Kim , M.D.1, Ho Sung Son , M.D., Ph.D.1, Jae Seung Jung , M.D., Ph.D.1

Departments of 1Thoracic and Cardiovascular Surgery and 2Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea

Correspondence to:Jae Seung Jung
Tel 82-2-920-6400
E-mail heartistcs@korea.ac.kr
ORCID
https://orcid.org/0000-0002-8848-4112

*These authors contributed equally to this work as the first authors.

Received: November 9, 2023; Revised: January 15, 2024; Accepted: January 26, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: In this study, we examined the impact of a patient blood management (PBM) program on red blood cell (RBC) transfusion practices in cardiothoracic surgery.
Methods: The PBM program had 3 components: monitoring transfusions through an order communication system checklist, educating the medical team about PBM, and providing feedback to ordering physicians on the appropriateness of transfusion. The retrospective analysis examined changes in the hemoglobin levels triggering transfusion and the proportions of appropriate RBC transfusions before, during, and after PBM implementation. Further analysis was focused on patients undergoing cardiac surgery, with outcomes including 30-day mortality, durations of intensive care unit and hospital stays, and rates of pneumonia, sepsis, and wound complications.
Results: The study included 2,802 patients admitted for cardiothoracic surgery. After the implementation of PBM, a significant decrease was observed in the hemoglobin threshold for RBC transfusion. This threshold dropped from 8.7 g/dL before PBM to 8.3 g/dL during the PBM education phase and 8.0 g/dL during the PBM feedback period. Additionally, the proportion of appropriate RBC transfusions increased markedly, from 23.9% before PBM to 34.9% and 58.2% during the education and feedback phases, respectively. Among the 381 patients who underwent cardiac surgery, a significant reduction was noted in the length of hospitalization over time (p<0.001). However, other clinical outcomes displayed no significant differences.
Conclusion: PBM implementation effectively reduced the hemoglobin threshold for RBC transfusion and increased the rate of appropriate transfusion in cardiothoracic surgery. Although transfusion practices improved, clinical outcomes were comparable to those observed before PBM implementation.

Keywords: Patient blood management, Transfusion, Cardiothoracic surgery

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