Strategies for Blood Conservation to Reduce Transfusion Rates in Abdominal Aortic Aneurysm Surgery

A Lamond, TM Mastracci, L Pawlowski, F Farrokhyar, JG Tittley
Division of Vascular Surgery, Department of Surgery and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario

Objectives:  In the endovascular era, abdominal aortic aneurysm repair using conventional, open techniques are becoming more complex.  Strategies to decrease the use of blood products are being sought to both decrease cost to the system and risk to the patient.  We describe the experience of our group after implementing use of a cell saver device and preferential admission to a step down unit, instead of the intensive care, and the effect it has had on blood transfusion rates.

Methods: Retrospective review of a single, tertiary care centre experience with all patients undergoing open abdominal aortic aneurysm surgery from three separate cohorts spanning 5 years (2003 – 2007).  The cohorts describe the experience with patients in the pre-cell saver era, admitted to ICU (Group A); cell saver era, admitted to ICU (Group B); cell saver era with preferential admission to the step down unit (Group C).  Data was collected retrospectively using two separate, independent databases to ensure that all patients were captured.  Descriptive statistics and univariate analysis was performed using SPSS. 

Results:  Data from 279 patients was collected (78 in group A, 109 in group B and 92 in Group C).  The mean age of the entire population was 72 years (standard deviation [SD] 7.3) and 81% were male.  There was no statistically significant difference in age, sex or coronary artery disease in any of the groups.  In group C, 62/92 (67%) patients were admitted to step down unit after surgery without requiring intensive care monitoring. There was a significant difference in all transfusions required and in packed red blood cell transfusions required between all the groups (Table 1).  If patients admitted to the intensive care unit are removed from Group C (N=30), the number of transfusions decreases even further to 21/62 (33.9%) for all transfusions and 18/62 (29.0%) for RBC transfusions only.

 
Conclusion: Implementation of proactive strategies at a tertiary care centre can have a significant effect in the number of transfusions given to patients who undergo conventional, open abdominal aortic aneurysm surgery.