Improved Cost-Effectiveness and Blood Product Utilization From Instituting a Blood Ordering Algorithm for Cardiac Surgical Cases

Semin Cardiothorac Vasc Anesth. 2018 Dec;22(4):353-358. doi: 10.1177/1089253218778602. Epub 2018 May 23.


Background: Results of a previous study revealed an over-ordering of blood products for cardiac surgery and led to the creation of a new blood ordering algorithm. This follow-up study has been conducted to evaluate improvement in ordering practices.

Methods: Retrospective data were collected for 171 patients who underwent coronary artery bypass grafting or valve surgery from March 2015 to March 2016 to determine the crossmatch-to-transfusion ratio (C:tx) and potential cost savings. Results were compared with pre-algorithm values and considered statistically significant if the 95% confidence interval did not include zero.

Results: Prior to the algorithm, 100% of patients undergoing cardiac surgery were crossmatched. After instituting the algorithm, this decreased to 15%. The overall C:tx decreased from 7.97 to 2.14. Cost savings were calculated as $114.79 (coronary artery bypass grafting) and $129.05 (valve surgery) per patient.

Conclusions: The creation of a new algorithm to guide ordering practices has significantly improved the C:tx, reduced unnecessary crossmatching, and lowered costs.

Keywords: blood loss; cardiac surgery; cardiopulmonary bypass; transfusion.

MeSH terms

  • Adult
  • Algorithms*
  • Blood Grouping and Crossmatching / methods
  • Blood Transfusion / economics
  • Blood Transfusion / methods*
  • Cardiac Surgical Procedures / economics
  • Cardiac Surgical Procedures / methods*
  • Coronary Artery Bypass / economics
  • Coronary Artery Bypass / methods*
  • Cost Savings
  • Cost-Benefit Analysis
  • Follow-Up Studies
  • Humans
  • Retrospective Studies