CLINICAL AND ECONOMIC BURDEN OF TRANSFUSION IN CARDIAC SURGERY- A SYSTEMATIC REVIEW
Author(s)
Ikeme S1, Rock M1, Bin Sawad A2, Kuntze E2, Martin M3
1Baxter Healthcare Corporation, Deerfield, IL, USA, 2Baxter Healthcare, Deerfield, IL, USA, 3inVentiv Health, London, UK
OBJECTIVES: We conducted a systematic review to identify published evidence from observational studies on the clinical and economic burden of transfusion in cardiac surgery. METHODS: We searched Embase, Pubmed and the Centre for Reviews and Dissemination (CRD) suite of databases for English language articles and analyzed these qualitatively. The search was limited to evidence published in the last 10 years (2006-2016). RESULTS: The review identified 16 publications and 15 were observational study design. Majority of the studies examined patients undergoing coronary artery bypass graft (CABG) and aortic valve replacement (AVR). The rate of transfusion ranged from 15% to 84% in those patients who experienced excessive bleeding after cardiac surgery. A significant reduction in transfusion rates and red blood cell (RBC) usage was observed with patients who did not experience bleeding, use blood conversation strategies and less invasive surgical techniques (n=6). Platelet use ranged from 9.8% to 84% and was significantly higher in patients who experienced bleeding or underwent re-exploration (n=5). Fresh Frozen Plasma (FFP) use ranged from 2.4% to 63% (n=5) and there was a significant difference in units of FFP transfused in patients with post-operative bleeding and re-exploration (n=2). Transfused cardiac surgery patients had significantly longer hospital stays, were more frequently hospitalized and utilized more ICU services. Total costs of blood and transfusions were highest in the United States and correlated significantly with transfusion rate. Mortality data (n=5) showed that patients who received transfusion had higher in-hospital (1.7%-3.07%) and long-term (5.8%-6.4%) mortality and a dose-dependent relationship between unit of packed RBC and higher odds for post-operative mortality. CONCLUSIONS: Transfusion of blood products and the resultant higher resource utilization in cardiac surgery patients pose substantial clinical burden to the patient and economic consequences to the hospital/health system. Reducing both factors has the potential to reduce patient morbidity and healthcare cost.
Conference/Value in Health Info
2017-05, ISPOR 2017, Boston, MA, USA
Value in Health, Vol. 20, No. 5 (May 2017)
Code
PCV110
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Cardiovascular Disorders