O uso de recuperador de sangue em cirurgia cardíaca com circulação extracorpórea / The use of cell saver system in cardiac surgery with cardiopulmonary bypass

INTRODUÇÃO: O uso de recuperador de sangue (RS) em cirurgia cardíaca é proposto para diminuir o uso de unidades de concentrado de hemácias estocadas (UCH), que aumenta morbidade, mortalidade e reações inflamatórias. OBJETIVO: O objetivo deste estudo é avaliar se o uso do RS diminui o emprego de UCH, é custo/efetivo e traz benefícios ao paciente. MÉTODOS: Estudo prospectivo realizado entre novembro de 2009 e outubro de 2011, em 100 pacientes consecutivos, submetidos à cirurgia cardiovascular com circulação extracorpórea (CEC), hemodiluição mínima e hemofiltração. Os pacientes foram divididos em grupo 1 (sem RS) e 2 (com RS). Os critérios para a reposição de UCH foram instabilidade hemodinâmica e hemoglobina (Hb) <7-8g/dl. Foram analisados dados demográficos, Hb, hematócrito (Ht), drenagem mediastinal e reposição de UCH, em diversos intervalos, e tempos de CEC, UTI e hospital. RESULTADOS: Nos grupos 1 e 2, a idade média foi de 64,2 e 60,6 anos, com predominância do sexo masculino, o EuroSCORE logístico de 10,3 e 9,6 e a mortalidade de 2% e 4%, não relacionada ao estudo. O grupo 2 apresentou incidência de reoperações superior (12 x 6%), mas o número de UCH usado (4,31x1,25) e o tempo de internamento hospitalar (10,8x7,4) foram menores. Realizada análise uni e multivariada, que não demonstrou valores estatisticamente significativos, exceto no uso de UCH. A relação entre o custo do RS e das UCH foi custo/efetiva e o tempo de internamento, menor. CONCLUSÃO: O uso de RS diminui o número de UCH usadas, não é custo/efetivo e mostrou benefícios ao paciente.

INTRODUCTION: The use of cell saver (CS) in cardiac surgery is proposed to reduce the use of units of packed red blood cells stored (URBC), which increases morbidity, mortality and causes inflammatory reactions. OBJECTIVE: The objective is to evaluate whether the use of CS decreases the use URBC, is cost /effective and beneficial to the patient. METHODS: In a prospective study, between November 2009 and October 2011, 100 consecutive patients who underwent cardiovascular surgery with CPB, hemodilution and hemofiltration, were enrolled. Patients were divided into group 1 (no CS) and 2 (CS). The criteria for the replacement of RBC were hemodynamic instability and hemoglobin (Hb) <7-8g/dl. Demographic data, as well as Hb and hematocrit, mediastinal drainage, number of URBC and CPB, ICU and hospital time, were analysed. RESULTS: In groups 1 and 2 the average age was 64.1 and 60.6 years; predominantly male; the logistic EuroSCORE 10.3 and 9.4; mortality 2% and 4%. Group 2 had a higher incidence of reoperations (12% versus 6%), but the average of URBC used (4.31 versus 1.25) and mean length of hospital stay (10.8 versus 7.4 days) was lower. Univariate and multivariate analysis, were performed, which showed no statistically significant values, except in the use of URBC. The relationship between the CS and the cost of RBC was not cost /effective and length of stay was shorter. CONCLUSION: The use of CS decreases the number of used URBC, is not cost /effective but has shown benefits for patients.

Análisis de costos en medicina transfusional / Cost analysis in transfusional medicine

El análisis de costo de la transfusión de hemocomponentes surge de la necesidad de evaluar si el canon percibido por las prestaciones realizadas a terceros absorbía los gastos incurridos. Se utilizó el método "Costo Directo o Variable" en la práctica transfusional para determinar el valor de las prestaciones. El cálculo se realizó en base a la determinación del objeto de costos, el cálculo de los costos variables y fijos y la asignación de costos. Los costos variables se distribuyeron utilizando el concepto del producto conjunto, mediante el enfoque de asignar los costos utilizando medición física. Los costos fijos se asignaron a cada hemocomponente según su "capacidad de soportar". Se concluyó que en general, en el ámbito de la salud siempre se midió la eficacia. En la actualidad esto no alcanza, debemos ser eficientes. La diferencia entre estos dos conceptos está dada por la relevancia que se le asigna a los costos. Si nos referimos al sector privado, para maximizar el beneficio; mientras que en el ámbito público para el cumplir con los presupuestos optimizando la utilización de los recursos disponibles. En lo particular este estudio permitió ver si éramos competitivos dentro del sector.

The cost analysis of the transfusion of hemocomponents comes from the need to evaluate whether the royalty perceived for the provisions granted to third parties was enough to cover costs. The method used was "Direct or Variable Cost" in transfusion practice to determine the value of provisions. The calculation was based on the determination of the object of costs, and the variable and fixed calculations and cost assignment. Variable costs were distributed using the concept of joint product, focusing on assigning costs using physical measure. Fixed costs were assigned to each hemocomponent according to the "capacity to support". It was concluded that in the health environment efficiency was always measured. At present, this in not enough and we must be efficient. The difference between these two concepts is highlighted by the importance given to costs. As regards the private sector, this is to maximize benefits while in the public sector this is to comply with the budgets optimizing the use of available resources. This case allowed us to analyse whether we were competitive in the sector.