Contemporary bloodletting in cardiac surgical care

Colleen Koch, Edmunds Z. Reineks, Anne S. Tang, Eric D. Hixson, Shannon Phillips, Joseph F. Sabik, J. Michael Henderson, Eugene H. Blackstone

Research output: Contribution to journalArticle

Abstract

Background Health care providers are seldom aware of the frequency and volume of phlebotomy for laboratory testing, bloodletting that often leads to hospital-acquired anemia. Our objectives were to examine the frequency of laboratory testing in patients undergoing cardiac surgery, calculate cumulative phlebotomy volume from time of initial surgical consultation to hospital discharge, and propose strategies to reduce phlebotomy volume. Methods From January 1, 2012 to June 30, 2012, 1,894 patients underwent cardiac surgery at Cleveland Clinic; 1,867 had 1 hospitalization and 27 had 2. Each laboratory test was associated with a test name and blood volume. Phlebotomy volume was estimated separately for the intensive care unit (ICU), hospital floors, and cumulatively. Results A total of 221,498 laboratory tests were performed, averaging 115 tests per patient. The most frequently performed tests were 88,068 blood gas analyses, 39,535 coagulation tests, 30,421 complete blood counts, and 29,374 metabolic panels. Phlebotomy volume differed between ICU and hospital floors, with median volumes of 332 mL and 118 mL, respectively. Cumulative median volume for the entire hospital stay was 454 mL. More complex procedures were associated with higher overall phlebotomy volume than isolated procedures; eg, combined coronary artery bypass grafting (CABG) and valve procedure median volume was 653 mL (25th/75th percentiles, 428 of 1,065 mL) versus 448 mL (284 of 658 mL) for isolated CABG and 338 mL (237 of 619) for isolated valve procedures. Conclusions We were astonished by the extent of bloodletting, with total phlebotomy volumes approaching amounts equivalent to 1 to 2 red blood cell units. Implementation of process improvement initiatives can potentially reduce phlebotomy volumes and resource utilization.

Original languageEnglish (US)
Pages (from-to)779-784
Number of pages6
JournalAnnals of Thoracic Surgery
Volume99
Issue number3
DOIs
StatePublished - Mar 1 2015
Externally publishedYes

Fingerprint

Bloodletting
Phlebotomy
Coronary Artery Bypass
Thoracic Surgery
Intensive Care Units
Blood Gas Analysis
Blood Cell Count
Blood Volume
Health Personnel
Names
Anemia
Length of Stay
Hospitalization
Referral and Consultation
Erythrocytes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Koch, C., Reineks, E. Z., Tang, A. S., Hixson, E. D., Phillips, S., Sabik, J. F., ... Blackstone, E. H. (2015). Contemporary bloodletting in cardiac surgical care. Annals of Thoracic Surgery, 99(3), 779-784. https://doi.org/10.1016/j.athoracsur.2014.09.062

Contemporary bloodletting in cardiac surgical care. / Koch, Colleen; Reineks, Edmunds Z.; Tang, Anne S.; Hixson, Eric D.; Phillips, Shannon; Sabik, Joseph F.; Henderson, J. Michael; Blackstone, Eugene H.

In: Annals of Thoracic Surgery, Vol. 99, No. 3, 01.03.2015, p. 779-784.

Research output: Contribution to journalArticle

Koch, C, Reineks, EZ, Tang, AS, Hixson, ED, Phillips, S, Sabik, JF, Henderson, JM & Blackstone, EH 2015, 'Contemporary bloodletting in cardiac surgical care', Annals of Thoracic Surgery, vol. 99, no. 3, pp. 779-784. https://doi.org/10.1016/j.athoracsur.2014.09.062
Koch C, Reineks EZ, Tang AS, Hixson ED, Phillips S, Sabik JF et al. Contemporary bloodletting in cardiac surgical care. Annals of Thoracic Surgery. 2015 Mar 1;99(3):779-784. https://doi.org/10.1016/j.athoracsur.2014.09.062
Koch, Colleen ; Reineks, Edmunds Z. ; Tang, Anne S. ; Hixson, Eric D. ; Phillips, Shannon ; Sabik, Joseph F. ; Henderson, J. Michael ; Blackstone, Eugene H. / Contemporary bloodletting in cardiac surgical care. In: Annals of Thoracic Surgery. 2015 ; Vol. 99, No. 3. pp. 779-784.
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