Impact of a Patient Blood Management monitoring and feedback programme on allogeneic blood transfusions and related costs.

A Patient Blood Management programme was established at the University Hospital of Zurich, along with a monitoring and feedback programme, at the beginning of 2014 with a first analysis reported in 2015. Our study aimed to investigate the further impact of this Patient Blood Management monitoring and feedback programme on transfusion requirements and related costs. We included adult patients discharged between 2012 and 2017. A total of 213,882 patients underwent analysis: 66,659 patients in the baseline period (2012-2013); 35,309 patients in the year after the introduction of the Patient Blood Management monitoring and feedback programme (2014) and 111,914 patients in the continued sustainability period (2015-2017). The introduction of the Patient Blood Management monitoring and feedback programme reduced allogeneic blood product transfusions by 35%, from 825 units per 1000 hospital discharges in 2012 to 536 units in 2017. The most sustained effect was an approximately 40% reduction in red blood cell transfusions, from 535 per 1000 discharges to 319 units. Fewer patients were transfused in the periods after the introduction of the Patient Blood Management monitoring and feedback programme (6251 (9.4%) vs. 2932 (8.3%) vs. 8196 (7.3%); p < 0.001). Compared with 2012, the yearly OR for being exposed to any blood transfusion declined steadily after the introduction of the Patient Blood Management monitoring and feedback programme to 0.64 (95%CI 0.61-0.68; p < 0.001) in 2017. For patients requiring extracorporeal membrane oxygenation, transfusion requirements were also sustainably reduced. This reduction in allogeneic blood transfusions led to savings of 12,713,754 Swiss francs (£ 9,497,000 sterling; EUR 11,100,000; US$ 12,440,000) in blood product acquisition costs over 4 years. In-hospital mortality was not affected by the programme. The Patient Blood Management monitoring and feedback programme sustainably reduced transfusion requirements and related costs, without affecting in-hospital mortality.

Young adults with mild traumatic brain injury--the influence of alcohol consumption--a retrospective analysis.

PURPOSE: Alcohol abuse has been associated with aggressive behavior and interpersonal violence. Aim of the study was to investigate the role of alcohol consumption in a population of young adults with mild traumatic brain injuries and the attendant epidemiological circumstances of the trauma. SUBJECTS AND METHODS: All cases of mild traumatic brain injury among young adults under 30 with an injury severity score <16 who were treated as inpatients between 2009 and 2012 at our trauma center were analyzed with regard to the influence of alcohol consumption by multiple regression analysis. RESULTS: 793 patients, 560 men, and 233 women were included. The age median was 23 (range 14-30). Alcohol consumption was present in 302 cases. Most common trauma mechanism was interpersonal violence followed by simple falls on even ground. Alcohol consumption was present more often in men, unemployed men, patients who had interpersonal violence as a trauma mechanism, and in patients who were admitted to the hospital at weekends or during night time. It also increased the odds ratio to suffer concomitant injuries, open wounds, or fractures independently from the trauma mechanism. Length of hospital stay or incapacity to work did not increase with alcohol consumption. CONCLUSIONS: Among young adults men and unemployed men have a higher statistical probability to have consumed alcohol prior to suffering mild traumatic brain injury. The most common trauma mechanism in this age group is interpersonal violence and occurs more often in patients who have consumed alcohol. Alcohol consumption and interpersonal violence increase the odds ratio for concomitant injuries, open wounds, and fractures independently from another.

[Kyphoplasty in osteoporotic spinal fractures]. / Kyphoplastie bei osteoporotischen Wirbelfrakturen.

Kyphoplasty has been the standard procedure for osteoporotic fractures for more than 5 years but the material costs are still very high. The aim of this study was to clarify whether pain reduction could be achieved without increasing the rate of new fractures and also in what areas costs could possibly be reduced. From 15.01.2007 until 15.01.2008, a total of 100 patients with 126 recent osteoporotic spinal fractures were treated by kyphoplasty with an average operation time of 38 min and follow-up times up to 12 months. During this follow-up period 15 lateral and 2 dorsal cement leakages remained asymptomatic and 1 dorsal leakage caused an incomplete paraparesis, which was finally cured completely. All patients were very content and pain measured on the visual analogous scale could be lowered from 8.0 before the operation to 2.7 points after the operation. With material costs of 3,056 Euro, there were additional operation costs of 247 Euro per case. The average effective weight was 2.84. On average 7,810 Euro returns could be achieved, deducting material and operation costs left 4,507 Euro per case. More than 40% of gains were reinvested in operation and material costs. Within 12 months 6 new fractures occurred despite medicinal prophylactic treatment which could also be successfully treated by kyphoplasty. The average visual analogous scale after 12 months was 2.1 points.Kyphoplasty still causes financial deficits due to high material costs, however, patients benefit from a reduction of pain.

[Operative treatment of instable osteoporotic spine fractures. A good guide in coding of diagnosis]. / Operative Versorgung instabiler osteoporotischer Wirbelsäulenfrakturen. Eine wichtige Kodierhilfe.

The combination of kyphoplasty and fixateur interne is an essential therapy with osteoporotic unstable fractures. Material costs of 5500 Euro are not sufficiently covered by returns through DRG I09. Thus operations are often performed in 2 stages, an initial one and a second 30 days later. This means more strain for the patient and partly also loss of correction. Therefore in 2008 we requested the InEK that codes for one-and two-segmental implantation of material in a vertebrae with preceding restoration of vertebral height (5-839.a0 and 5-839.a1) combined with a percutaneous dorsal operation with a screw-rod system in the future would be represented by I19B in G-DRG system with returns of 11,110,40 Euro. Prerequirement is coding of kyphoplastiy as main procedure and percutaneous implantation of a fixateur with procedure 5-835.5. Some procedures in orthopedic surgery implying technical improvements and rising implant costs are not sufficiently rewarded. Thus is make sense to inform InEK by corresponding proposals.

[Minimally invasive percutaneous instrumentation for spine fractures]. / Minimal-invasive perkutane Instrumentation bei Wirbelsäulenfrakturen.

When operating unstable spine fractures by an open dorsal approach, detachment of paravertebral muscles results in bleeding and later functional disturbances. Long incisions over spinous processes cause pain and later cosmetic issues. With the sextant of Medtronic a system is at our disposal which permits a percutaneous approach with pedicle screws and longitudinal supports by a target device via six small incisions. From 15 November 2007 until 15 May 2008, 36 unstable spine fractures were treated by a minimally invasive technique; 14 men and 22 women were treated. The average age was 61 years (22-88 years). According to the Magerl classification there were mostly A3.3 fractures. The average incision-closure time was 42 min (14-96 min) with an average X-ray exposure time of 3.35 min (1.5-7 min). Blood loss was 10-20 ml and average hospital stay was 11 days. Pain judged according to a visual analog scale decreased from 6.1 to 1.4 points. Incorrect screw positions without clinical relevance were seen in 2% without necessity for revision. From 1 February 2007 until 15 November 2007, 40 patients (24 men, 16 women, average age 53 years) with unstable spine fractures were treated by the same surgeons by open dorsal instrumentation. The average operation time in this control group was 91 min and the average time at hospital 15.5 days. Percutaneous instrumentation with cannulation of pedicles with a guide wire under X-ray control permits a safe application while preserving soft tissues without relevant blood loss. Operating times can be drastically reduced compared with the open technique. The implants are more expensive but pay for themselves by shorter stays in the OR and hospital.