Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Improvement of Transfusion Practice in Cardiothoracic Surgery Through Implementing a Patient Blood Management Program

  • Hee Jung Kim (Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine) ;
  • Hyeon Ju Shin (Department of Anesthesiology and Pain Medicine, Korea University College of Medicine) ;
  • Suk Woo Lee (Department of Anesthesiology and Pain Medicine, Korea University College of Medicine) ;
  • Seonyeong Heo (Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine) ;
  • Seung Hyong Lee (Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine) ;
  • Ji Eon Kim (Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine) ;
  • Ho Sung Son (Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine) ;
  • Jae Seung Jung (Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine)
  • Received : 2023.11.09
  • Accepted : 2024.01.26
  • Published : 2024.07.05
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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

Acknowledgement

The authors would like to extend their gratitude to R.N. Mi Kyung Lee at the Bloodless Medicine Center.

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