Harrison O J, Rahaman N C
University of Bristol, United Kingdom.
West Indian Med J. 2012 Sep;61(6):587-91.
To investigate the intraoperative transfusion requirements in off-pump coronary artery bypass grafting (OPCABG) and the cost implication of blood products and cell savers on a background of limited resources.
Prospective data collection identified 60 patients undergoing OPCABG surgery at the Eric Williams Medical Sciences Complex, Trinidad and Tobago. Data relating to these patients (including preoperative haemoglobin (Hb), graft number, presence of diabetes, ejection fraction, preoperative serum creatinine, intraoperative blood use and blood loss) and costing for cell saver disposables and prepared donor (or allogenic) blood were obtained.
Twenty units of packed red blood cells (pRBCs) were given in theatre to 27% (16 of 60) of patients. Transfusion requirement was significantly lower in patients with fewer grafts, higher preoperative Hb level and non-diabetic patients. Cell saver disposables and one unit of pRBCs were estimated to cost TT$5000 and TT$1700, respectively. Each patient's transfusion cost TT$2125.00 per unit.
The study demonstrates the financial implications of routine cell saver use in OPCABG in a setting of limited resources. The cost-effectiveness of routine cell saver use remains to be elucidated, but we recommend the selective use of cell savers in patients who are at a higher risk for transfusion.
在资源有限的背景下，调查非体外循环冠状动脉搭桥术（OPCABG）中的术中输血需求以及血液制品和血液回收机的成本影响。
前瞻性数据收集确定了特立尼达和多巴哥埃里克·威廉姆斯医学科学综合大楼60例接受OPCABG手术的患者。获取了与这些患者相关的数据（包括术前血红蛋白（Hb）、移植血管数量、糖尿病情况、射血分数、术前血清肌酐、术中用血和失血情况）以及血液回收机耗材和制备好的供体（或异体）血液的成本。
术中向27%（60例中的16例）的患者输注了20单位的浓缩红细胞（pRBC）。移植血管较少、术前Hb水平较高的患者以及非糖尿病患者的输血需求明显较低。血液回收机耗材和1单位pRBC的估计成本分别为5000特立尼达和多巴哥元及1700特立尼达和多巴哥元。每位患者的输血成本为每单位2125.00特立尼达和多巴哥元。
该研究表明在资源有限的情况下，OPCABG中常规使用血液回收机的财务影响。常规使用血液回收机的成本效益仍有待阐明，但我们建议在输血风险较高的患者中选择性使用血液回收机。
