Aplicação do índice de pacientes transfundidos e do índice de utilização de concentrado de hemácias no serviço de hemoterapia do Hospital Universitário Cassiano Antônio de Moraes, como ferramenta para melhoria das práticas hemoterápicas transfusionais

• Autor(a) principal: Marcondes, Sibia Soraya
• Data de Publicação: 2017
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da Universidade Federal do Espírito Santo (riUfes)
• Texto Completo: http://repositorio.ufes.br/handle/10/8336
• topic: Blood transfusion; Surgery; Hospitals university; Costs and cost analysis; Transfusão de sangue; Custo e análise de custo; Sangue - Transfusão; Cirurgia; Hospitais universitários; Medicina; 61

Introduction: Studies show that about 30-60% of blood units prepared for transfusion are not transfused. Prepared and non-transfused blood products (BPs) cause greater reagent consumption and the demand of human ressources. Reducing the preparation of blood products is a good way to minimize the costs and optimize their rational use. Objectives: a) Identify the request profile and utilization of BPs in the elective surgeries and the impact of the demographic, clinic and laboratory variables and surgery time in the number of transfusions; b) Develop a Maximum Surgical Blood Order Schedule (MSBOS) in the Hospital Universitário Cassiano Antônio de Moraes (HUCAM); c) Demonstrate the reagents costs for the pre-surgery reservation and the possibility of savings. Methods: Observational Study, carried out in the period from 01/02/2015 to 31/01/2016 at the teaching hospital HUCAM. During this period, clinic, sociodemographic (gender, age, diagnosis, type of surgery) and quantitative data (regarding the number of request and utilization of red blood cells (RBC) in the electives surgeries) were collected. Using the blood consumption rate it was possible to create a MSBOS and calculate the standard costs for the RBC request and the possible savings using the MSBOS. Results: 822 procedures with PRC demand were evaluated. The average age was 55,1 years (95% IC 54,1; 56,2). The median of PRC was a total of 3 units (0-8). The median of platelets reservation was zero, except in the cardio surgeries (8 units (0-10)). The median of fresh-frozen plasma request was 3 units (0-10). 135 patients were transfused (16,4%). The transfusion rate in the cardio surgeries was 50%, followed by gastrointestinal surgery (25%), vascular (16,5%), gynaecological (11%), urology (9,5%) and thoracic (8,1%). The factors which affected the transfusion were: age (OR 1.025, 95% IC 1.006, 1.045), surgery time (OR 1.004, 95% IC 1.001, 1.006) and the cardio surgeries (OR 7,83 95% IC 1.58, 38.74). Among the 51 types of evaluated surgeries, 22 presented an index of transfused patients (ITP)> 10% and 29 ITP <10%, and the MSBOS was developed. Cardio surgery has the most significant PRC request cost (median: R$ 49,73; min 35,5 – max 77,89), ginecologiy the lowest (median: R$ 35,65; min 28,61 – max 49,73) p<0,01. When apllying any MSBOS methodology the savings are about 17% - 37%. Conclusion: The median of RBC request was lower for gynecology and greater for cardio surgery. Most surgeries did not use the requested PRCs. Factors such as age, surgery time and cardio surgery increased the chance of RBC use. All the specialties could save with the costs of requesting RBC and the possibility of saving is greater in the cardio surgeries.