HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Martin Hartrumpf Johannes M. Albes Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Spalding, G. J. Articles by Albes, J. M. Search for Related Content PubMed PubMed Citation Articles by Spalding, G. J. Articles by Albes, J. M. Related Collections Cardiac - other

Eur J Cardiothorac Surg 2007;31:1052-1057. doi:10.1016/j.ejcts.2007.02.022
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Cost reduction of perioperative coagulation management in cardiac surgery: value of ‘bedside’ thrombelastography (ROTEM)

^a Department of Cardiovascular Surgery, Heart Center Brandenburg, Bernau/Berlin, Germany
^b Department of Anaesthesiology, Heart Center Brandenburg, Bernau/Berlin, Germany

Received 27 September 2006; received in revised form 26 February 2007; accepted 27 February 2007.

^_* Corresponding author. Address: Department of Cardiovascular Surgery, Heart Center Brandenburg, Ladeburger Strasse 17, 16321 Bernau bei Berlin, Germany. Tel.: +49 3338 694510; fax: +49 3338 694544. (Email: j.albes{at}immanuel.de).

Objective: Demographic changes and aggressive platelet inhibition have resulted in a marked increase in blood- and coagulation product expenditure and costs in cardiac surgery. We analyzed ‘bedside’ coagulation test (ROTEM) in order to verify clot forming quality for the purpose of finding a cost-effective treatment path. Methods: Annual treatment costs of all cardiosurgical patients were analyzed before (729 patients) and after (693 patients) implementation of ‘bedside’ ROTEM. Cumulative numbers and costs of platelet concentrates (PltC), fresh frozen plasma (FFP), red blood cell units (RBC), and coagulation factors: pooled coagulation concentrates (PCC), recombinant factor VIIa (rFVIIa), factor XIII (FXIII), and fibrinogen were assessed. Average monthly numbers and costs were compared. Number of resternotomies and early mortality was assessed and compared in both periods. Results: After ROMTEM implementation cumulative RBC expenditure showed 25% decrease while PltC exhibited 50% decrease. FFP expenditure remained unchanged. PCC, FXIII were markedly reduced (–80%) while rFVIIa were entirely omitted. Fibrinogen, however, increased two-fold. Cumulative average monthly costs of all blood products decreased from 66,000\#8364; to 45,000\#8364; (–32%). Coagulation factor average monthly costs decreased from 60,000\#8364; to 30,000\#8364; (–50%) yielding combined savings of 44%. In contrast, average monthly costs for ROTEM were 1.580\#8364;. Total number of resternotomies decreased from 6.6% to 5.5% while early mortality (5.9%; 6.0%) remained stable. Conclusion: Cumulative costs for treatment of perioperative coagulation disorders can be reduced by ‘bedside’ ROTEM analysis to achieve a selective substitution management. Saved costs for blood- and coagulation products clearly outweighed the expenses of ROTEM. Adequate differential coagulation management can therefore be cost-effective.

Key Words: Cardiac surgery • Cost-reduction • Coagulation management • Blood product consumption

This article has been cited by other articles:

				N. Rahe-Meyer, C. Solomon, M. Winterhalter, S. Piepenbrock, K. Tanaka, A. Haverich, and M. Pichlmaier Thromboelastometry-guided administration of fibrinogen concentrate for the treatment of excessive intraoperative bleeding in thoracoabdominal aortic aneurysm surgery. J. Thorac. Cardiovasc. Surg., September 1, 2009; 138(3): 694 - 702. [Abstract] [Full Text] [PDF]

				W. C. Oliver Anticoagulation and Coagulation Management for ECMO Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2009; 13(3): 154 - 175. [Abstract] [PDF]

				N. Rahe-Meyer, M. Pichlmaier, A. Haverich, C. Solomon, M. Winterhalter, S. Piepenbrock, and K. A. Tanaka Bleeding management with fibrinogen concentrate targeting a high-normal plasma fibrinogen level: a pilot study Br. J. Anaesth., June 1, 2009; 102(6): 785 - 792. [Abstract] [Full Text] [PDF]

				M. Hartrumpf, T. Claus, M. Erb, and J. M. Albes Surgeon performance index: tool for assessment of individual surgical quality in total quality management Eur. J. Cardiothorac. Surg., May 1, 2009; 35(5): 751 - 758. [Abstract] [Full Text] [PDF]

				P. Moor, T. Woolley, M. Midwinter, C. Fenger-Eriksen, J. Ingerslev, and B. Sorensen Coagulation tests in future studies: what to use? Br. J. Anaesth., May 1, 2009; 102(5): 716 - 717. [Full Text] [PDF]

				A. Straub, D. Schiebold, H. P. Wendel, C. Hamilton, T. Wagner, E. Schmid, K. Dietz, and G. Ziemer Using reagent-supported thromboelastometry (ROTEM(R)) to monitor haemostatic changes in congenital heart surgery employing deep hypothermic circulatory arrest Eur. J. Cardiothorac. Surg., September 1, 2008; 34(3): 641 - 647. [Abstract] [Full Text] [PDF]

				M. T. Ganter and C. K. Hofer Coagulation Monitoring: Current Techniques and Clinical Use of Viscoelastic Point-of-Care Coagulation Devices Anesth. Analg., May 1, 2008; 106(5): 1366 - 1375. [Abstract] [Full Text] [PDF]

				T. Haas, D. Fries, C. Velik-Salchner, E. Oswald, and P. Innerhofer Fibrinogen in Craniosynostosis Surgery Anesth. Analg., March 1, 2008; 106(3): 725 - 731. [Abstract] [Full Text] [PDF]

				T. Vanek, M. Jares, J. Snircova, and M. Maly Fibrinolysis in coronary artery surgery: detection by thromboelastography Interactive CardioVascular and Thoracic Surgery, December 1, 2007; 6(6): 700 - 704. [Abstract] [Full Text] [PDF]