[ Comparison of bloodless and classic methods of coronary artery bypass grafting in Chamran hospital, Isfahan]

ABSTRACT

The idea of bloodless medicine and surgery emerged when physicians had to treat patients who defied transfusion for religious reasons [e.g. Jehovah's Witnesses]; moreover, problems in ensuring safe blood supplies, the relevant costs involved, and the post-transfusion complications gave also rise to bloodless method. The aim of this study is to evaluate the reduction of allogenic blood transfusion, postoperative infection and costs in the bloodless group compared to the control. A retrospective comparative study was undertaken for patients undergoing coronary artery bypass grafting [CABG] at Isfahan's Chamran hospital. Two groups of patients undergoing the classic CABG and the Bloodless techniques were compared [100 patients in each group]. For bloodless surgery in addition to considering principles of bloodless medicine and surgery, autologous normovolemic hemodilution was done before operation [1-2 units] and patients were not transfused unless their hemoglobin was 9 gm/dl. Data were analysed by t-test and Chi-square test. Various factors were compared between these two techniques such as units of packed cells [PC] and fresh frozen plasma [FFP] transfused, length of hospital stay, costs and postoperative complications [infection, bleeding, etc.]. In bloodless and classic surgery groups, 76% and 38% did not require PC transfusion, respectively. In addition, we observed a significant difference between FFP transfusion in the bloodless [93%] and classic technique [73%]. No patient in the bloodless group received platelets whereas 2% of the patients in the classic group did. Overall length of hospital stay and ICU stay were less in the bloodless method; hence, the costs were less too. Postoperative infection was less in the bloodless method. These differences were significant. The application of bloodless method for patients undergoing CABG significantly reduces PC and FFP consumption [P=0.001]; therefore, the complications of blood transfusion such as post transfusion HIV, hepatitis, allergic and immunological reactions are decreased. Length of hospital stay and postoperative infections are also reduced which in turn reduce the costs [P=0.001, 0.001 and 0.037, respectively]