Blood conservation pediatric cardiac surgery in all ages and complexity levels

AIM To demonstrate the feasibility of blood conservation methods and practice across all ages and risk categories in congenital cardiac surgery.METHODS We retrospectively analyzed a collected database of 356 patients who underwent cardiac surgery using cardiopulmonary bypass(CPB) from 2010-2015. The patients were grouped into blood conservation(n = 138) and nonconservation(n = 218) groups and sub-grouped based on their ages and procedural complexity scores. RESULTS There were no statistical differences in gender,weight,pre-operative and pre-CPB hematocrit levels in both groups. Despite equivalent hematocrit levels during and after CPB for both groups,there was significantly less operative homologous blood utilized in blood conservation group across all ages and complexity levels. CONCLUSION Blood conservation surgery can be performed in con-genital patients needing cardiac surgery in all age groups and complexity categories. The above findings in addition to attendant risks and side effects of blood transfusion and the rising cost of safer blood products justify blood conservation in congenital cardiac surgery.

Reducing unnecessary crossmatching for hip fracture patients by accounting for preoperative hemoglobin concentration

BACKGROUND Maximum surgical blood order schedules were designed to eliminate unnecessary preoperative crossmatching prior to surgery in order to conserve blood bank resources.Most protocols recommend type and cross of 2 red blood cell(RBC)units for patients undergoing surgery for treatment of hip fracture.Preoperative hemoglobin has been identified as the strongest predictor of inpatient transfusion,but current maximum surgical blood order schedules do not consider preoperative hemoglobin values to determine the number of RBC units to prepare prior to surgery.AIM To determine the preoperative hemoglobin level resulting in the optimal 2:1 crossmatch-to-transfusion(C:T)ratio in hip fracture surgery patients.METHODS In 2015 a patient blood management(PBM)program was implemented at our institution mandating a single unit-per-occurrence transfusion policy and a restrictive transfusion threshold of<7 g/dL hemoglobin in asymptomatic patients and<8 g/dL in those with refractory symptomatic anemia or history of coronary artery disease.We identified all hip fracture patients between 2013 and 2017 and compared the preoperative hemoglobin which would predict a 2:1 C:T ratio in the pre PBM and post PBM cohorts.Prediction profiling and sensitivity analysis were performed with statistical significance set at P<0.05.RESULTS Four hundred and ninety-eight patients who underwent hip fracture surgery between 2013 and 2017 were identified,291 in the post PBM cohort.Transfusion requirements in the post PBM cohort were lower(51%vs 33%,P<0.0001)than in the pre PBM cohort.The mean RBC units transfused per patient was 1.15 in the pre PBM cohort,compared to 0.66 in the post PBM cohort(P<0.001).The 2:1 C:T ratio(inpatient transfusion probability of 50%)was predicted by a preoperative hemoglobin of 12.3 g/dL[area under the curve(AUC)0.78(95%confidence interval(CI),0.72-0.83),Sensitivity 0.66]in the pre PBM cohort and 10.7 g/dL[AUC 0.78(95%CI,0.73-0.83),Sensitivity 0.88]in the post PBM cohort.A 50%probability of requiring>1 RBC unit was predicted by 11.2g/dL[AUC 0.80(95%CI,0.74-0.85),Sensitivity 0.87]in the pre PBM cohort and 8.7g/dL[AUC 0.78(95%CI,0.73-0.83),Sensitivity 0.84]in the post-PBM cohort.CONCLUSION The hip fracture maximum surgical blood order schedule should consider preoperative hemoglobin in determining the number of units to type and cross prior to surgery.