Hemostasis Checklist Reduces Bleeding and Blood Product Consumption After Cardiac Surgery
| Autor: | Jason M. Ali, James Clayton, Caroline Gerrard, Narain Moorjani |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Postoperative Hemorrhage 030204 cardiovascular system & hematology law.invention 03 medical and health sciences 0302 clinical medicine law Blood product Humans Medicine Blood Transfusion Prospective Studies Cardiac Surgical Procedures Prospective cohort study Aged Aged 80 and over Hemostatic Techniques business.industry Perioperative Middle Aged Intensive care unit Checklist Surgery Cardiac surgery 030228 respiratory system Hemostasis Female Cardiology and Cardiovascular Medicine business Complication |
| Zdroj: | The Annals of Thoracic Surgery. 111:1570-1577 |
| ISSN: | 0003-4975 |
| Popis: | Considerable mediastinal bleeding is a recognized complication after cardiac surgery and may require reexploration and blood product transfusion, both of which are associated with inferior clinical outcomes with greater morbidity and mortality. The aim of this study was to develop a hemostasis checklist, with the intention of reducing mediastinal bleeding after cardiac surgery.A hemostasis checklist was developed with multidisciplinary collaboration. It contains 2 components: a series of surgical sites and factors affecting coagulation status. The checklist is performed at a time-out before sternal wire insertion. Analysis compared outcomes for patients undergoing cardiac surgery in the 1 year before and 2 years after implementation.A total of 5542 patients underwent surgery during the study. After we implemented the checklist, there was a significant reduction in the reexploration rate (3.5% versus 1.9%; P.001) and the proportion of patients bleeding greater than 1 L in 12 hours (6.1% versus 2.8%; P.001). There was a major reduction in consumption of blood products, saving $430,513. There was progressive improvement in the second year after implementation. Checklist implementation was also associated with reduced intensive care unit and hospital length of stay, adding to the financial benefit.Implementation of a simple and quickly performed hemostasis checklist has had a sustained impact over the 2 years after implementation, reducing the incidence of noteworthy mediastinal bleeding and reexploration, which has resulted in a major reduction in blood product consumption. Together, these have resulted in an associated reduction in intensive care unit and hospital length of stay, and a considerable financial savings. This highlights that perioperative bleeding is a preventable complication. |
| Databáze: | OpenAIRE |
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