COMPREHENSIVE MULTIMODALITY BLOOD CONSERVATION - 100 CONSECUTIVE CABGOPERATIONS WITHOUT TRANSFUSION

Background. Despite the recent introduction of a number of technical a nd pharmacologic blood conservation measures, bleeding and allogeneic transfusion remain persistent problems in open heart surgical procedur es. We hypothesized that a comprehensive multimodality blood conservat ion program applied algorithmically on the basis of bleeding and trans fusion risk would provide a maximum, cost-effective, and safe reductio n in postoperative bleeding and allogeneic blood transfusion. Methods. One hundred consecutive patients undergoing coronary artery bypass gr afting were prospectively enrolled in a risk factor-based multimodalit y blood conservation program (MMD group). To evaluate the relative eff icacy and safety of this comprehensive approach, comparison was made w ith a similar group of 90 patients undergoing coronary artery bypass g rafting to whom the multimodality blood conservation program was not a pplied but in whom an identical set of transfusion guidelines was enfo rced (control group). To evaluate the cost effectiveness of the multim odality program, comparison was also made between patients in the MMD group and a consecutive series of contemporaneous, diagnostic-related group-matched patients. Results. One hundred consecutive patients in t he MMD group underwent coronary artery bypass grafting without allogen eic transfusion. This compared favorably with the control population i n whom a mean of 2.2 +/- 6.7 units of allogeneic blood was transfused per patient (34 patients [38%] received transfusion). In addition, the volume of postoperative blood loss at 12 hours in the control group w as almost double that of the MMD group (660 +/- 270 mL versus 370 +/- 180 mL [p < 0.001]). Total costs for the MMD group in each of the thre e major diagnostic-related groups were equivalent to or significantly less than those in the consecutive series of diagnostic-related group- matched patients. Conclusions. Comprehensive risk factor-based applica tion of multiple blood conservation measures in an optimized, integrat ed, and algorithmic manner can significantly decrease bleeding and nee d of allogeneic transfusion in coronary artery bypass grafting in a sa fe and cost-effective manner. (C) 1998 by The Society of Thoracic Surg eons.