MIT
MANAGEMENT SLOAN SCHOOL
15-167 May 7, 2016
Conserving Blood During Cardiac Surgery at Huntington University Hospital (A) Abeel A. Mangi, Cate Reavis, and Roberto Fernandez
Patients who underwent cardiac surgery often required a blood transfusion or other blood products. In order for surgeons to work upon or inside the heart, certain parts of the heart or great vessels surrounding it needed to be opened and then repaired with suture material. Opening a chamber of the heart disrupted its hermetic seal and permitted blood to spill out and into the surrounding space. While bleeding was undesirable for obvious reasons, restoring blood via transfusions was not a panacea. According to a 2006 study published in the Annals of Thoracic Surgery, a cardiac patient who received a blood transfusion after an aortic valve replacement (AVR) or a coronary artery bypass grafting (CABG) had a 30% lower chance of survival at six months and a 50% lower chance at 10 years.1 The 10-year survival rate without a transfusion was 90%.2
On average, 48.9% of patients in the United States who underwent an AVR or a CABG required a blood transfusion.3 At Huntington University Hospital (HUH), where 500 patients underwent an AVR or CABG annually, the percentage of patients who received blood transfusions in 2011, 2012, and 2013 was around 71%. This was happening at a time when the Affordable Care Act of 2010 was forcing hospitals to provide quality care in a cost efficient way.
Dr. Frank Young, who joined HUH’s for Cardiac Medicine in 2011 and whose patients were among the hospital’s sickest, wanted to help bring down the Center’s transfusion rate by leading a blood conservation project involving the medical teams that worked together during the intra- and post-
‘ Koch, C.G., et al. “Transfusion in CABG Is Associated with Reduced Long-Term Survival,” Annals of Thoracic Surgery, 2006, 81:1650-1657. 2 Ibid. 3 Ibid.
This case was prepared by Abeel A. Mangi, EMBA Class of 2016, Cate Reavis, Associate Director, Curriculum Development, and Professor Roberto Fernandez. Names and certain data have been disguised. Copyright @ 2016, Abeel A. Mangi, Cate Reavis, and Roberto Fernandez. This work is licensed under the Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 Unported License. To view a copy of this license visit http://creativecommons.orq/licenses/by-nc-nd/3.0/ or send a letter to Creative Commons, 171 Second Street, Suite 300, San Francisco, California, 94105, USA.
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