| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 1994;57:161-168
© 1994 The Society of Thoracic Surgeons
a Program in Medical Information Science, Department of Family and Community Medicine, and Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, New Hampshire, USA
b Departments, of Surgery, Pathology, and Medicine, Section of Cardiothoracic Surgery, and Technology Assessment Program, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
c Departments of Medicine and Pathology, Washington University Medical Center, St. Louis, Missouri, USA
Accepted for publication March 5, 1993.
* Address reprint requests to Dr Birkmeyer, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756.
Concern about the safety of the aliogeneic blood supply has made preoperative autologous blood donation (PAD) routine before major noncardiac operations. However, the costs and benefits of PAD in elective coronary artery bypass grafting (CABG) are not well established. We used decision analysis to (1) calculate the cost-effectiveness of PAD in CABG, expressed as cost per year of life saved, and (2) compare the health benefits of reducing aliogeneic transfusions with the potential risks of autologous blood donation by patients with coronary artery disease. A prospective study of 18 institutions provided data on transfusion practice and blood product costs in CABG. On average, PAD in CABG costs $508,000 to $909,000 per quality-adjusted year of life saved, depending on the number of units donated. Pieoperative autologous blood donation is more cost-effective (as low as $158,000 per year of life saved) when targeted to younger patients undergoing CABG at centers with high transfusion rates. The cost-effectiveness of PAD is strongly dependent on estimates of posttransfusion hepatitis incidence, but less so on plausible estimates of the current risk of human immunodeficiency virus transmission. Although the actual risk of PAD is uncertain, even a small fatality rigk (>1 per 101,000 donations) associated with blood donation by patients awaiting CABG negates all life expectancy benefits of PAD. At current costs, FAD by patients awaiting CABG is not cost-effective, producing small health benefits at high societal cost. For the individual patient, the risk of donating blood before CABG may well outweigh the benefits associated with fewer allogeneic transfusions.
This article has been cited by other articles:
|
|
 |
|
  L. Uhl Patient Blood Management: A 68-Year-Old Woman Contemplating Autologous Blood Donation Before Elective Surgery JAMA, November 2, 2011; 306(17): 1902 - 1910. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. D. Slight, O. Nzewi, D. B. L. McClelland, and P. S. Mankad Red cell transfusion in elective cardiac surgery patients: where do we go from here? Br. J. Anaesth., March 1, 2009; 102(3): 294 - 296. [Full Text] [PDF]
|
|
|
|
 |
|
 B. Custer, M. P. Busch, A. A. Marfin, and L. R. Petersen The Cost-Effectiveness of Screening the U.S. Blood Supply for West Nile Virus Ann Intern Med, October 4, 2005; 143(7): 486 - 492. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. C. Arora, J.-F. Legare, K. J. Buth, J. A. Sullivan, and G. M. Hirsch Identifying Patients at Risk of Intraoperative and Postoperative Transfusion in Isolated CABG: Toward Selective Conservation Strategies Ann. Thorac. Surg., November 1, 2004; 78(5): 1547 - 1554. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. O. Tengs and T. H. Lin A Meta-Analysis of Utility Estimates for HIV/AIDS Med Decis Making, December 1, 2002; 22(6): 475 - 481. [Abstract] [PDF]
|
|
|
|
|
|
R. Ascione, G. Iannelli, K. H.H. Lim, H. Imura, and N. Spampinato One-stage coronary and abdominal aortic operation with or without cardiopulmonary bypass: early and midterm follow-up Ann. Thorac. Surg., September 1, 2001; 72(3): 768 - 774. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M H Cross Autotransfusion in cardiac surgery Perfusion, September 1, 2001; 16(5): 391 - 400. [Abstract] [PDF]
|
|
|
|
 |
|
 R. Ascione, S. Williams, C. T. Lloyd, T. Sundaramoorthi, A. A. Pitsis, and G. D. Angelini Reduced postoperative blood loss and transfusion requirement after beating-heart coronary operations: A prospective randomized study J. Thorac. Cardiovasc. Surg., April 1, 2001; 121(4): 689 - 696. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Ascione, C. T. Lloyd, M. J. Underwood, A. A. Lotto, A. A. Pitsis, and G. D. Angelini Economic outcome of off-pump coronary artery bypass surgery: a prospective randomized study Ann. Thorac. Surg., December 1, 1999; 68(6): 2237 - 2242. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Zohar, B. Fredman, M. Ellis, I. Luban, A. Stern, and R. Jedeikin A Comparative Study of the Postoperative Allogeneic Blood-Sparing Effect of Tranexamic Acid Versus Acute Normovolemic Hemodilution After Total Knee Replacement Anesth. Analg., December 1, 1999; 89(6): 1382 - 1382. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. T. Goodnough, G. J. Despotis, C. W. Hogue Jr, and T. B. Ferguson Jr On the need for improved transfusion indicators in cardiac surgery Ann. Thorac. Surg., August 1, 1995; 60(2): 473 - 480. [Abstract] [PDF]
|
|
|
|
|
|
L. Sandrelli, A. Pardini, R. Lorusso, M. L. Sala, M. Licenziati, and O. Alfieri Impact of autologous blood predonation on a comprehensive blood conservation program Ann. Thorac. Surg., March 1, 1995; 59(3): 730 - 735. [Abstract] [PDF]
|
|
|
|
 |
|
 L. T. Goodnough, M. S. Bodner, and J. W. Martin Blood Transfusion and Blood Conservation: Cost and Utilization Issues American Journal of Medical Quality, December 1, 1994; 9(4): 172 - 183. [Abstract] [PDF]
|
|
|
|
|
|
J. P. AuBuchon and J. D. Birkmeyer Safety and Cost-effectiveness of Solvent-Detergent--Treated Plasma: In Search of a Zero-Risk Blood Supply JAMA, October 19, 1994; 272(15): 1210 - 1214. [Abstract] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
