Predictors and Economic Impact of Red Blood Cell Transfusion in Cardiac Surgery: A Simulated Cost Reduction Model for Preoperative Anemia Management

Matilde Cerqueira Silva; João Maia; Ana Lídia Rouxinol-Dias; Cláudia Almeida

doi:10.20344/amp.23502

Autores

Matilde Cerqueira Silva Faculdade de Medicina. Universidade do Porto. Porto.
João Maia Department of Anesthesiology. Unidade Local de Saúde São João. Porto. https://orcid.org/0000-0002-0277-0012
Ana Lídia Rouxinol-Dias Department of Anesthesiology. Unidade Local de Saúde São João. Porto. & CINTESIS@RISE. Centre for Health Technology and Services Research. Faculty of Medicine. University of Porto. Porto. & Department of Community Medicine. Information and Health Decision Sciences (MEDCIDS). Faculty of Medicine. University of Porto. Porto. https://orcid.org/0000-0002-2542-9730
Cláudia Almeida Department of Anesthesiology. Unidade Local de Saúde São João. Porto.

DOI:

https://doi.org/10.20344/amp.23502

Palavras-chave:

Anemia/prevenção e controlo, Custos e Análise de Custo, Custos Hospitalares, Procedimentos Cirúrgicos Cardíacos, Tempo de Internamento, Transfusão de Eritrócitos/economia

Resumo

Introdução: As transfusões de glóbulos vermelhos (GV) são frequentes em cirurgia cardíaca e estão associadas a maior morbimortalidade, tempo de internamento e custos hospitalares. Diversos fatores relacionados com o doente e com o procedimento têm sido identificados como preditores de transfusão. O estudo destes preditores em populações específicas permite uma estratificação de risco mais precisa. Este estudo teve como objetivo identificar fatores de risco independentes de transfusão de GV na nossa amostra, avaliar o seu impacto económico e estimar as potenciais poupanças de custos decorrentes da eliminação da anemia pré-operatória.
Métodos: Realizou-se um estudo de coorte retrospetivo, num hospital terciário em Portugal, incluindo 661 adultos submetidos a cirurgia cardíaca eletiva entre abril de 2020 e abril de 2021. O outcome primário foi a necessidade de pelo menos uma transfusão de GV durante o internamento. Outcomes secundários incluíram mortalidade aos 30 dias, infeção, lesão renal aguda, ventilação mecânica prolongada, tempo de internamento hospitalar e custos hospitalares. Os fatores de risco independentes foram identificados através de regressão logística multivariável. Uma análise económica comparou os custos entre doentes transfundidos e não transfundidos. Para estimar a redução de custos, desenvolveu-se um modelo de simulação assumindo a eliminação da anemia pré-operatória e aplicando os padrões de transfusão observados nos doentes não anémicos à coorte.
Resultados: A prevalência de transfusão foi 41,3%. Os preditores identificados foram a anemia pré-operatória (OR 3,67; 2,00 - 6,74), sexo feminino (OR 2,06; 1,22 - 3,48), EuroSCORE II mais elevado (OR 1,15; 1,03 - 1,29), maior tempo de bypass cardiopulmonar (OR 1,01; 1,00 - 1,02) e menor hemoglobina nadir intraoperatória (OR 0,48; 0,40 - 0,58), após ajuste para hemorragia pós-operatória. Doentes transfundidos apresentaram maior tempo de internamento (mediana de 10 vs 8 dias) e custos superiores (aumento mediano de €2264,44). Após ajuste para infeção e ventilação prolongada, a transfusão deixou de estar independentemente associada ao tempo de internamento. A eliminação da anemia pré-operatória poderia evitar 47 transfusões, reduzir 94 dias de internamento e poupar €106 429 em 13 meses.
Conclusão: A transfusão de GV foi associada a maior tempo de internamento, provavelmente devido a maiores taxas de infeção e ventilação mecânica prolongada. A correção da anemia pré-operatória poderá potencialmente reduzir as taxas de transfusão e os custos hospitalares relacionados com a cirurgia cardíaca. Estes resultados reforçam a relevância e económica da anemia pré-operatória.

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