Cost reduction of perioperative coagulation management in cardiac surgery: value of ‘bedside’ thrombelastography (ROTEM)

Objective: Demographic changes and aggressive platelet inhibition have resulted in a marked increase in blood- and coagulation product expenditure and costs in cardiac surgery. We analyzed ‘bedside’ coagulation test (ROTEM) in order to verify clot forming quality for the purpose of finding a cost-ef...

Full description

Saved in:

Bibliographic Details
Published in:	European journal of cardio-thoracic surgery Vol. 31; no. 6; pp. 1052 - 1057
Main Authors:	Spalding, Grit J., Hartrumpf, Martin, Sierig, Tobias, Oesberg, Nils, Kirschke, Christian Günther, Albes, Johannes M.
Format:	Journal Article
Language:	English
Published:	Amsterdam Elsevier Science B.V 01-06-2007 Elsevier Science
Subjects:	Aged Antithrombin III - economics Aprotinin - economics Biological and medical sciences Blood Coagulation Disorders - economics Blood Coagulation Disorders - prevention & control Blood Coagulation Factors - economics Blood Coagulation Tests Blood Platelets Blood product consumption Cardiac surgery Cardiac Surgical Procedures - economics Cardiac Surgical Procedures - methods Coagulation management Cost-Benefit Analysis Cost-reduction Deamino Arginine Vasopressin - economics Erythrocytes Female Health Care Costs Humans Male Medical sciences Plasma Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Thrombelastography - economics Thrombelastography - methods Cost-reduction Cardiac surgery Coagulation management Blood product consumption Consumption Blood product Bed Blood coagulation Point-of-care testing Costs Cardiovascular disease Patient Perioperative Reduction Clinical management Point of care testing Heart disease Health economy Economic aspect Public health
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Objective: Demographic changes and aggressive platelet inhibition have resulted in a marked increase in blood- and coagulation product expenditure and costs in cardiac surgery. We analyzed ‘bedside’ coagulation test (ROTEM) in order to verify clot forming quality for the purpose of finding a cost-effective treatment path. Methods: Annual treatment costs of all cardiosurgical patients were analyzed before (729 patients) and after (693 patients) implementation of ‘bedside’ ROTEM. Cumulative numbers and costs of platelet concentrates (PltC), fresh frozen plasma (FFP), red blood cell units (RBC), and coagulation factors: pooled coagulation concentrates (PCC), recombinant factor VIIa (rFVIIa), factor XIII (FXIII), and fibrinogen were assessed. Average monthly numbers and costs were compared. Number of resternotomies and early mortality was assessed and compared in both periods. Results: After ROMTEM implementation cumulative RBC expenditure showed 25% decrease while PltC exhibited 50% decrease. FFP expenditure remained unchanged. PCC, FXIII were markedly reduced (−80%) while rFVIIa were entirely omitted. Fibrinogen, however, increased two-fold. Cumulative average monthly costs of all blood products decreased from 66,000€ to 45,000€ (−32%). Coagulation factor average monthly costs decreased from 60,000€ to 30,000€ (−50%) yielding combined savings of 44%. In contrast, average monthly costs for ROTEM were 1.580€. Total number of resternotomies decreased from 6.6% to 5.5% while early mortality (5.9%; 6.0%) remained stable. Conclusion: Cumulative costs for treatment of perioperative coagulation disorders can be reduced by ‘bedside’ ROTEM analysis to achieve a selective substitution management. Saved costs for blood- and coagulation products clearly outweighed the expenses of ROTEM. Adequate differential coagulation management can therefore be cost-effective.
Bibliography:	istex:81A9C4C99C80B8C45F1AC0575C56B363D6EF93A6 ark:/67375/HXZ-RPXJWKZ1-7 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1010-7940 1873-734X
DOI:	10.1016/j.ejcts.2007.02.022