Goodnough Lawrence Tim, Soegiarso R Wida, Birkmeyer John D, Welch H Gilbert
From the Department of Medicine and Pathology, Washington University, St. Louis, Missouri USA.
From the Ireland Cancer Center, University Hospitals of Cleveland, Cleveland, Ohio, USA.
Am J Med. 1993 May;94(5):509-514. doi: 10.1016/0002-9343(93)90086-5.
In addition to historically important issues of blood inventory and blood safety, the costs of blood transfusion are anticipated to have an increasingly important impact on transfusion practices. To address this, we analyzed costs of blood support given to patients undergoing coronary artery bypass graft (CABG) surgery, along with costs of blood components whose transfusions were identified to be unnecessary.
Blood components transfused as part of a previously reported national, multicenter audit of 30 adult patients each at 18 institutions undergoing primary, elective CABG surgery were reviewed.
The range of blood purchase costs among institutions was broad, varying over two-fold. The range of red cell units transfused varied over 10-fold, and the range of total components transfused varied over 40-fold. The number of blood components transfused unnecessarily represented 27% of all blood units transfused, ranging from 7% to 43% among institutions. Inappropriate transfusions accounted for 47%, 32%, and 15% of all platelet, plasma, and red cell units transfused. The mean institutional cost for all blood components transfused per patient was $397 +/- $244. The cost per patient of components transfused inappropriately was 24% of this, or $96 +/- $89 (mean +/- SD).
These costs could be reduced with practice guidelines and quality improvement programs aimed at reducing the number of inappropriate transfusions.
除了在历史上重要的血液库存和血液安全问题外，输血成本预计对输血实践的影响将日益重要。为解决这一问题，我们分析了为接受冠状动脉搭桥术（CABG）的患者提供血液支持的成本，以及已确定不必要输血的血液成分的成本。
回顾了作为先前报告的一项全国性、多中心审计的一部分而输注的血液成分，该审计涉及18家机构中每组30名接受初次择期CABG手术的成年患者。
各机构之间血液采购成本范围广泛，相差两倍多。输注红细胞单位的范围相差10倍以上，输注的总成分范围相差40倍以上。不必要输注的血液成分数量占所有输注血液单位的27%，各机构之间从7%到43%不等。不适当输血分别占所有输注血小板、血浆和红细胞单位的47%、32%和15%。每位患者输注所有血液成分的平均机构成本为397美元±244美元。不适当输注成分的每位患者成本为其中的24%，即96美元±89美元（平均值±标准差）。
通过旨在减少不适当输血数量的实践指南和质量改进计划，可以降低这些成本。
