Blood product utilisation for coronary artery bypass graft surgery at a public and a private hospital in Western Cape Province, South Africa

Abstract

Background. Numerous studies have documented variation in transfusion practice for coronary artery bypass graft (CABG) surgery, despite the widespread availability of clinical guidelines. Blood management systems seek to streamline utilisation, with key indicators being patient care and outcome as well as reduction of waste and cost. Objectives. To facilitate this view, this study sought to audit blood product utilisation for CABG surgery at a private and a public sector hospital in Western Cape Province, South Africa. Methods. A retrospective audit of 100 consecutive patients undergoing CABG surgery at a private and a public hospital during 2017 was performed. Blood product use was compared between the two hospitals, and the influence of confounding factors such as gender, weight, age, pre- and intraoperative medications, type and complexity of the procedure, and patient comorbidities was analysed. Results. The proportion of patients receiving red cell concentrates (RCCs) at the public hospital was significantly higher than at the private hospital (92% v. 56%; p<0.001), which resulted in significantly higher postoperative haemoglobin concentrations (p<0.001). Although the increased proportion of RCC transfusion observed at the public hospital may have been influenced by decreased body mass (p<0.001), the patient population at the private hospital was older (p<0.05) and had higher rates of ischaemia (p<0.001), increased numbers of grafts (p<0.001) and higher preoperative use of aspirin (p<0.05). Conclusions. This study demonstrated increased use of blood products at the public hospital, despite performing fewer grafts. Although this study had limitations, which included low patient numbers and the inclusion of only two hospitals, we concluded that there is a significant variation in the use of blood products despite the risks associated with blood transfusion. These findings could be used to employ systems that will lead to improved blood usage practices.