Original Article

Retrospective Analysis of Thromboelastography-Directed Transfusion in Isolated CABG: Impact on Blood Product Use, Cost, and Outcomes

^* Research Department, ProMedica Toledo Hospital, Toledo, Ohio
^† ProMedica Toledo Hospital, Department of Cardiothoracic Surgery, Toledo, Ohio
^‡ ProMedica Toledo Hospital, Department of Perfusion Services, Toledo, Ohio; and
^§ Department of Mathematics and Statistics, Bowling Green State University, Bowling Green, Ohio

Address correspondence to: Michael Moront, MD, Cardiothoracic Surgeons for Northwest Ohio, ProMedica Toledo Hospital, 2109 Hughes Drive, #720, Toledo, OH 43606. E-mail: morontmd@icloud.com

Received: 8 January 2020
Accepted: 30 March 2020

Abstract

Cardiac surgeries account for approximately 20% of blood use in the United States. Allogeneic transfusion has been associated with increased risk of morbidity and mortality, further justifying the need to reduce blood use. This study aimed at determining whether a point-of-care coagulation test, thromboelastography (TEG), impacted blood product administration and outcomes. Patients undergoing isolated coronary artery bypass grafting (CABG) were retrospectively reviewed before the use of TEG (2008–2009) (n = 640) and after implementation (2011–2012) (n = 458). Blood product use was compared between time frames. Logistic regression and generalized linear models were created to estimate the impact on outcomes including the reoperation rate, mortality, and cost. The mean use of each blood product was significantly reduced in the perioperative period. Overall blood product use was decreased by over 40%. Mediastinal re-exploration of bleeding was significantly reduced with TEG (4.8 vs. 1.5%). Six-month mortality was not impacted in this cohort nor was the readmission rate or hospital length of stay. However, blood cost and patient charges were significantly lower after TEG was introduced. The use of TEG to guide the administration of blood products during isolated CABG significantly affected the amounts and types of products given intra- and perioperatively. This resulted in less chest tube drainage, fewer returns to the operating room, and more accurate diagnosis of coagulopathic status. Cost savings to the patient and institution were appreciated as a consequence of these improved clinical outcomes.