Kane Lauren C, Woodward Cathy S, Husain Syed Adil, Frei-Jones Melissa J
Department of Cardiothoracic Surgery, University of Texas Health Sciences Center San Antonio, San Antonio, Texas.
Department of Pediatrics, University of Texas Health Sciences Center San Antonio, San Antonio, Texas.
J Surg Res. 2016 Jan;200(1):21-7. doi: 10.1016/j.jss.2015.07.011. Epub 2015 Jul 10.
The administration of blood products during pediatric cardiac surgery is common. We sought to determine if thromboelastography (TEG) is a cost-effective tool to reduce blood product transfusion in open pediatric cardiac surgery.
A retrospective case-control study was undertaken for 150 pediatric cardiac patients requiring cardiopulmonary bypass from January 2010-May 2012, in a University-affiliated pediatric hospital. Fifty sequential patients operated on when TEG was used were compared with 100 control patients before TEG availability. Groups were matched 2:1 for age and risk adjustment for congenital heart surgery score. Blood product utilization was compared between groups, as were outcomes metrics such as postoperative complications, length of stay, and hospital costs of transfusions.
Demographic variables, risk adjustment for congenital heart surgery score classifications, and cardiopulmonary bypass times were similar between groups. Red cell and plasma transfusion were comparable between groups. TEG patients saw a substantial reduction in the administration of platelet (1 versus 2.2 U; P < 0.0001) and cryoprecipitate (0.7 versus 1.7 U; P < 0.0001) transfusions. A greater than 50% reductions in hospital costs of platelet ($595 versus $1309) and cryoprecipitate ($39 versus $94) transfusions were observed in the TEG group. Mortality, length of stay, ventilator requirements, postoperative bleeding, and thrombotic events were equivalent.
Intraoperative TEG use reduced platelet and cryoprecipitate transfusions without an increase in postoperative complications. TEG is a cost-effective method to direct blood product replacement.
小儿心脏手术中血液制品的输注很常见。我们试图确定血栓弹力图（TEG）是否是一种具有成本效益的工具，可减少小儿心脏直视手术中的血液制品输注。
2010年1月至2012年5月，在一家大学附属医院对150例需要体外循环的小儿心脏患者进行了一项回顾性病例对照研究。将使用TEG时连续手术的50例患者与TEG可用之前的100例对照患者进行比较。根据年龄和先天性心脏病手术评分的风险调整将两组按2:1进行匹配。比较两组之间的血液制品利用率，以及术后并发症、住院时间和输血住院费用等结果指标。
两组之间的人口统计学变量、先天性心脏病手术评分分类的风险调整和体外循环时间相似。两组之间的红细胞和血浆输注相当。TEG组患者的血小板输注量（1单位对2.2单位；P<0.0001）和冷沉淀输注量（0.7单位对1.7单位；P<0.0001）大幅减少。TEG组血小板输血的住院费用（595美元对1309美元）和冷沉淀输血的住院费用（39美元对94美元）降低了50%以上。死亡率、住院时间、呼吸机需求、术后出血和血栓形成事件相当。
术中使用TEG可减少血小板和冷沉淀输注，且不增加术后并发症。TEG是一种指导血液制品替代的具有成本效益的方法。
