Optimizing Blood Transfusion Practices Through Bundled Intervention Implementation in Patients With Gynecologic Cancer Undergoing Laparotomy

Sumer K. Wallace, Jessica W. Halverson, Christopher J. Jankowski, Stephanie R. DeJong, Amy L. Weaver, Megan R. Weinhold, Bijan J Borah, James P. Moriarty, William Arthur Cliby, Daryl J Kor, Andrew A. Higgins, Hilary A. Otto, Sean Christopher Dowdy, Jamie N Bakkum-Gamez

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE: To examine blood transfusion practices and develop a standardized bundle of interventions to address the high rate of perioperative red blood cell transfusion among patients with ovarian and endometrial cancer. METHODS: This was a retrospective cohort study. Our primary aim was to determine whether an implemented bundled intervention was associated with a reduction in perioperative red blood cell transfusions among cases of laparotomy for cancer. Secondary aims included comparing perioperative demographic, surgical, complication, and cost data. Interventions included blood transfusion practice standardization using American Society of Anesthesiologists guidelines, an intraoperative hemostasis checklist, standardized intraoperative fluid status communication, and evidence-based use of tranexamic acid. Prospective data from women undergoing laparotomy for ovarian or endometrial cancer from September 28, 2015, to May 31, 2016, defined the study cohort and were compared with historical controls (September 1, 2014, to September 25, 2015). Outcomes were compared in the full unadjusted cohorts and in propensity-matched cohorts. RESULTS: In the intervention and historical cohorts, respectively, 89 and 184 women underwent laparotomy for ovarian cancer (n=74 and 152) or advanced endometrial cancer (n=15 and 32). Tranexamic acid was administered in 54 (60.7%) patients. The perioperative transfusion rate was lower for the intervention group compared with historical controls (18.0% [16/89] vs 41.3% [76/184], P<.001), a 56.4% reduction. This improvement in the intervention group remained significant after propensity matching (16.2% [13/80] vs 36.2% [29/80], P=.004). The hospital readmission rate was also lower for the intervention group compared with historical controls (1.1% [1/89] vs 12.5% [23/184], P=.002); however, this improvement did not attain statistical significance after propensity matching (1.2% [1/80] vs 7.5% [6/80], P=.12). Cost analysis demonstrated that this intervention was cost-neutral during index hospitalization plus 30-day follow-up. CONCLUSION: Application of a standardized bundle of evidence-based interventions was associated with reduced blood use in our gynecologic oncology practice.

Original languageEnglish (US)
Pages (from-to)891-898
Number of pages8
JournalObstetrics and gynecology
Volume131
Issue number5
DOIs
StatePublished - May 1 2018

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Endometrial Neoplasms
Blood Transfusion
Ovarian Neoplasms
Laparotomy
Tranexamic Acid
Erythrocyte Transfusion
Costs and Cost Analysis
Cohort Studies
Patient Readmission
Neoplasms
Hemostasis
Checklist
Hospitalization
Retrospective Studies
Communication
Demography
Guidelines

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Optimizing Blood Transfusion Practices Through Bundled Intervention Implementation in Patients With Gynecologic Cancer Undergoing Laparotomy. / Wallace, Sumer K.; Halverson, Jessica W.; Jankowski, Christopher J.; DeJong, Stephanie R.; Weaver, Amy L.; Weinhold, Megan R.; Borah, Bijan J; Moriarty, James P.; Cliby, William Arthur; Kor, Daryl J; Higgins, Andrew A.; Otto, Hilary A.; Dowdy, Sean Christopher; Bakkum-Gamez, Jamie N.

In: Obstetrics and gynecology, Vol. 131, No. 5, 01.05.2018, p. 891-898.

Research output: Contribution to journalArticle

Wallace, Sumer K. ; Halverson, Jessica W. ; Jankowski, Christopher J. ; DeJong, Stephanie R. ; Weaver, Amy L. ; Weinhold, Megan R. ; Borah, Bijan J ; Moriarty, James P. ; Cliby, William Arthur ; Kor, Daryl J ; Higgins, Andrew A. ; Otto, Hilary A. ; Dowdy, Sean Christopher ; Bakkum-Gamez, Jamie N. / Optimizing Blood Transfusion Practices Through Bundled Intervention Implementation in Patients With Gynecologic Cancer Undergoing Laparotomy. In: Obstetrics and gynecology. 2018 ; Vol. 131, No. 5. pp. 891-898.
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abstract = "OBJECTIVE: To examine blood transfusion practices and develop a standardized bundle of interventions to address the high rate of perioperative red blood cell transfusion among patients with ovarian and endometrial cancer. METHODS: This was a retrospective cohort study. Our primary aim was to determine whether an implemented bundled intervention was associated with a reduction in perioperative red blood cell transfusions among cases of laparotomy for cancer. Secondary aims included comparing perioperative demographic, surgical, complication, and cost data. Interventions included blood transfusion practice standardization using American Society of Anesthesiologists guidelines, an intraoperative hemostasis checklist, standardized intraoperative fluid status communication, and evidence-based use of tranexamic acid. Prospective data from women undergoing laparotomy for ovarian or endometrial cancer from September 28, 2015, to May 31, 2016, defined the study cohort and were compared with historical controls (September 1, 2014, to September 25, 2015). Outcomes were compared in the full unadjusted cohorts and in propensity-matched cohorts. RESULTS: In the intervention and historical cohorts, respectively, 89 and 184 women underwent laparotomy for ovarian cancer (n=74 and 152) or advanced endometrial cancer (n=15 and 32). Tranexamic acid was administered in 54 (60.7{\%}) patients. The perioperative transfusion rate was lower for the intervention group compared with historical controls (18.0{\%} [16/89] vs 41.3{\%} [76/184], P<.001), a 56.4{\%} reduction. This improvement in the intervention group remained significant after propensity matching (16.2{\%} [13/80] vs 36.2{\%} [29/80], P=.004). The hospital readmission rate was also lower for the intervention group compared with historical controls (1.1{\%} [1/89] vs 12.5{\%} [23/184], P=.002); however, this improvement did not attain statistical significance after propensity matching (1.2{\%} [1/80] vs 7.5{\%} [6/80], P=.12). Cost analysis demonstrated that this intervention was cost-neutral during index hospitalization plus 30-day follow-up. CONCLUSION: Application of a standardized bundle of evidence-based interventions was associated with reduced blood use in our gynecologic oncology practice.",
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AU - Wallace, Sumer K.

AU - Halverson, Jessica W.

AU - Jankowski, Christopher J.

AU - DeJong, Stephanie R.

AU - Weaver, Amy L.

AU - Weinhold, Megan R.

AU - Borah, Bijan J

AU - Moriarty, James P.

AU - Cliby, William Arthur

AU - Kor, Daryl J

AU - Higgins, Andrew A.

AU - Otto, Hilary A.

AU - Dowdy, Sean Christopher

AU - Bakkum-Gamez, Jamie N

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N2 - OBJECTIVE: To examine blood transfusion practices and develop a standardized bundle of interventions to address the high rate of perioperative red blood cell transfusion among patients with ovarian and endometrial cancer. METHODS: This was a retrospective cohort study. Our primary aim was to determine whether an implemented bundled intervention was associated with a reduction in perioperative red blood cell transfusions among cases of laparotomy for cancer. Secondary aims included comparing perioperative demographic, surgical, complication, and cost data. Interventions included blood transfusion practice standardization using American Society of Anesthesiologists guidelines, an intraoperative hemostasis checklist, standardized intraoperative fluid status communication, and evidence-based use of tranexamic acid. Prospective data from women undergoing laparotomy for ovarian or endometrial cancer from September 28, 2015, to May 31, 2016, defined the study cohort and were compared with historical controls (September 1, 2014, to September 25, 2015). Outcomes were compared in the full unadjusted cohorts and in propensity-matched cohorts. RESULTS: In the intervention and historical cohorts, respectively, 89 and 184 women underwent laparotomy for ovarian cancer (n=74 and 152) or advanced endometrial cancer (n=15 and 32). Tranexamic acid was administered in 54 (60.7%) patients. The perioperative transfusion rate was lower for the intervention group compared with historical controls (18.0% [16/89] vs 41.3% [76/184], P<.001), a 56.4% reduction. This improvement in the intervention group remained significant after propensity matching (16.2% [13/80] vs 36.2% [29/80], P=.004). The hospital readmission rate was also lower for the intervention group compared with historical controls (1.1% [1/89] vs 12.5% [23/184], P=.002); however, this improvement did not attain statistical significance after propensity matching (1.2% [1/80] vs 7.5% [6/80], P=.12). Cost analysis demonstrated that this intervention was cost-neutral during index hospitalization plus 30-day follow-up. CONCLUSION: Application of a standardized bundle of evidence-based interventions was associated with reduced blood use in our gynecologic oncology practice.

AB - OBJECTIVE: To examine blood transfusion practices and develop a standardized bundle of interventions to address the high rate of perioperative red blood cell transfusion among patients with ovarian and endometrial cancer. METHODS: This was a retrospective cohort study. Our primary aim was to determine whether an implemented bundled intervention was associated with a reduction in perioperative red blood cell transfusions among cases of laparotomy for cancer. Secondary aims included comparing perioperative demographic, surgical, complication, and cost data. Interventions included blood transfusion practice standardization using American Society of Anesthesiologists guidelines, an intraoperative hemostasis checklist, standardized intraoperative fluid status communication, and evidence-based use of tranexamic acid. Prospective data from women undergoing laparotomy for ovarian or endometrial cancer from September 28, 2015, to May 31, 2016, defined the study cohort and were compared with historical controls (September 1, 2014, to September 25, 2015). Outcomes were compared in the full unadjusted cohorts and in propensity-matched cohorts. RESULTS: In the intervention and historical cohorts, respectively, 89 and 184 women underwent laparotomy for ovarian cancer (n=74 and 152) or advanced endometrial cancer (n=15 and 32). Tranexamic acid was administered in 54 (60.7%) patients. The perioperative transfusion rate was lower for the intervention group compared with historical controls (18.0% [16/89] vs 41.3% [76/184], P<.001), a 56.4% reduction. This improvement in the intervention group remained significant after propensity matching (16.2% [13/80] vs 36.2% [29/80], P=.004). The hospital readmission rate was also lower for the intervention group compared with historical controls (1.1% [1/89] vs 12.5% [23/184], P=.002); however, this improvement did not attain statistical significance after propensity matching (1.2% [1/80] vs 7.5% [6/80], P=.12). Cost analysis demonstrated that this intervention was cost-neutral during index hospitalization plus 30-day follow-up. CONCLUSION: Application of a standardized bundle of evidence-based interventions was associated with reduced blood use in our gynecologic oncology practice.

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