Tarek Ansari, Saleema Wani, Axel Hofmann, Nanda Shetty, Kanan Sangani, Clifford J Stamp, Kevin Murray, Kevin M Trentino
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引用次数: 0
Abstract
Background: Obstetric patient blood management (PBM) strategies were used at Corniche Hospital in 2018, initially focusing on minimizing bleeding, with other clinical strategies implemented incrementally. This study assesses program outcomes in patients with major obstetric hemorrhage of 2000 mL or greater.
Methods: A retrospective study of 353 women admitted to The Corniche Hospital between 2018 and 2023 who experienced major obstetric hemorrhage of 2000 mL or greater. The primary outcome measure was units of red blood cell (RBC), fresh-frozen plasma (FFP), and platelet units transfused. Secondary outcomes included pretransfusion hemoglobin in patients with no active bleeding, hemoglobin levels 3 weeks postdischarge, anemia predelivery, blood product-acquisition cost savings, mortality, composite morbidity (transfusion reaction, acute lung injury, thrombosis, sepsis, postpartum hysterectomy), hospital and high-dependency unit length of stay, and all-cause emergency readmissions within 28 days.
Results: Comparing baseline (2018) with the final year (2023), the mean units of RBCs, FFP, and platelets transfused per admission decreased from 4.18 to 0.67 (P-trend <.001), resulting in blood acquisition savings of US$ 175,705. Over the same period the percentage of women anemic predelivery decreased from 40.3% to 23.8% (P-trend = 0.015) and the mean pretransfusion hemoglobin level in nonactively bleeding patients decreased from 7.54 g/dL to 6.35 g/dL (P-trend < .001). The mean hemoglobin rise 3 weeks postdischarge increased from 2.41 g/dL in 2018 to 4.26 g/dL in 2023. There were no changes in adjusted composite morbidity, hospital, or high-dependency unit length of stay.
Conclusions: In women with a major obstetric hemorrhage of 2000 mL or greater, the implementation of an obstetric PBM program was associated with reduced blood product utilization, reduced costs, reduced anemia, and increased hemoglobin rise postdischarge.
期刊介绍：
Anesthesia & Analgesia exists for the benefit of patients under the care of health care professionals engaged in the disciplines broadly related to anesthesiology, perioperative medicine, critical care medicine, and pain medicine. The Journal furthers the care of these patients by reporting the fundamental advances in the science of these clinical disciplines and by documenting the clinical, laboratory, and administrative advances that guide therapy. Anesthesia & Analgesia seeks a balance between definitive clinical and management investigations and outstanding basic scientific reports. The Journal welcomes original manuscripts containing rigorous design and analysis, even if unusual in their approach.
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