Mohandas Anita, Foley Kathleen A, Nash David B, Doria Cataldo
Jefferson School of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Qual Manag Health Care. 2011 Oct-Dec;20(4):298-310. doi: 10.1097/QMH.0b013e3182315d22.
Many different methods are used to manage surgical bleeding and reduce transfusion. Techniques vary by institution, resulting in inconsistent outcomes. We reviewed the current literature on the quality and costs of transfusions, focusing on prevention and management of transfusions during surgery, and provide recommendations on future directions for quality improvement (QI).
Ovid, PubMed, and Scopus.
Key words included QI, blood loss, transfusion, hemostasis, and costs. Inclusion criteria were English language, publication between 1999 and 2010, and primary end points of blood loss, transfusion, or hemostasis.
A total of 1331 abstracts were reviewed; 43 met the inclusion criteria.
A variety of bleeding management (BM) techniques were identified, with multiple studies suggesting that algorithms combining pre-, peri-, and postoperative interventions have the greatest potential to minimize transfusions. Most studies assessing the economic impact of BM interventions excluded resources beyond blood acquisition cost and longer-term complications, which may underestimate transfusion costs and bias estimates of the cost-effectiveness of interventions. Despite consensus on avoiding inappropriate transfusions, little agreement exists on optimal use of interventions.
Multifaceted algorithms show promising results. Future QI should focus on reducing practice variation via evidence-based guidelines for effective use of BM interventions.
多种不同方法用于处理手术出血并减少输血。技术因机构而异，导致结果不一致。我们回顾了当前关于输血质量和成本的文献，重点关注手术期间输血的预防和管理，并就质量改进（QI）的未来方向提供建议。
Ovid、PubMed和Scopus。
关键词包括质量改进、失血、输血、止血和成本。纳入标准为英文、1999年至2010年期间发表以及失血、输血或止血的主要终点。
共审查了1331篇摘要；43篇符合纳入标准。
确定了多种出血管理（BM）技术，多项研究表明，结合术前、术中和术后干预措施的算法最有可能将输血降至最低。大多数评估BM干预措施经济影响的研究排除了血液获取成本和长期并发症以外的资源，这可能会低估输血成本并使干预措施成本效益的估计产生偏差。尽管在避免不适当输血方面已达成共识，但在干预措施的最佳使用方面几乎没有一致意见。
多方面的算法显示出有前景的结果。未来的质量改进应侧重于通过基于证据的有效使用BM干预措施的指南来减少实践差异。
