An Analysis of the Economic Impact of Patient Blood Management in Cardiovascular Surgery
Keywords:
Economic Outcomes, Cost-Effectiveness, Patient Blood Management, Cardiovascular SurgeryAbstract
This study analyzes the economic impact of Patient Blood Management (PBM) in cardiovascular surgery through a qualitative review of secondary evidence from clinical, economic, and policy literature. The findings demonstrate that conventional transfusion dependent practices impose substantial direct and indirect costs due to high blood product utilization, transfusion-related complications, and prolonged hospital stays. In contrast, PBM strategies particularly preoperative anemia management, restrictive transfusion thresholds, and optimized intraoperative blood conservation consistently reduce transfusion rates, postoperative morbidity, intensive care utilization, and length of hospitalization. Economic evaluations indicate that although PBM requires initial investment, these costs are rapidly offset by significant savings and favorable returns on investment, supporting PBM as a high value, cost-effective approach that aligns improved patient outcomes with sustainable healthcare resource utilization in cardiovascular surgery.
Downloads
References
1. Al‐Riyami, A. Z., Louw, V. J., Indrikovs, A. J., Nedelcu, E., Bakhtary, S., Eichbaum, Q. G., ... & Education Subcommittee of the AABB Global Transfusion Forum. (2021). Global survey of transfusion medicine curricula in medical schools: Challenges and opportunities. Transfusion, 61(2), 617-626.
2. Anthes, E. (2015). Evidence-based medicine: Save blood, save lives. Nature, 520(7545), 24–26. https://doi.org/10.1038/520024a
3. Bracey, A. W., Yates, S. G., DeAnda, A., Jr., et al. (2025). Current state of patient blood management in cardiovascular surgery: Insights from a survey of leading centers. Journal of Cardiothoracic and Vascular Anesthesia. Advance online publication. https://doi.org/10.1053/j.jvca.2025.08.061
4. Céspedes, I. C., Figueiredo, M. S., Hossne, N. A., Suriano, Í. C., Rodrigues, R. D. C., Barros, M. M. O., ... & Panfilio, C. E. (2024). Patient blood management program implementation: comprehensive recommendations and practical strategies. Brazilian Journal of Cardiovascular Surgery, 39(5), e20240205.
5. Chen, L. X., & Koyner, J. L. (2015). Biomarkers in acute kidney injury. Critical care clinics, 31(4), 633-648.
6. de Vasconcelos Vaena, M. M., & Alves, L. A. (2019). Assessment of the knowledge and perceptions of Brazilian medical residents on transfusion medicine. Hematology, transfusion and cell therapy, 41(1), 37-43.
7. Frank, S. M., Hensley, N. B., Thomas, A. J., et al. (2024). Greater than sevenfold return on investment for a comprehensive patient blood management program with equivalent or improved outcomes. Anesthesia & Analgesia, 138, 1345–1348.
8. Grant, M. C., Crisafi, C., Alvarez, A., Arora, R. C., Brindle, M. E., Chatterjee, S., ... & Engelman, D. T. (2024). Perioperative care in cardiac surgery: a joint consensus statement by the enhanced recovery after surgery (ERAS) cardiac society, ERAS international society, and the society of thoracic surgeons (STS). The Annals of thoracic surgery, 117(4), 669-689.
9. Hofmann, A., Farmer, S., & Shander, A. (2020). Five drivers shifting the paradigm from product‐focused transfusion practice to patient blood management. The oncologist, 16(S3), 3-11.
10. Ivascu Girardi, N., Cushing, M. M., Evered, L. A., et al. (2023). Incidence and impact of a single-unit red blood cell transfusion: Analysis of the Society of Thoracic Surgeons Database (2010–2019). The Annals of Thoracic Surgery, 115, 1035–1041.
11. Jadwin, D. F., Fenderson, P. G., Friedman, M. T., Jenkins, I., Shander, A., Waters, J. H., ... & Reynolds, J. D. (2023). Determination of unnecessary blood transfusion by comprehensive 15-hospital record review. The Joint Commission Journal on Quality and Patient Safety, 49(1), 42-52.
12. Jeppsson, A., (Co-Chairperson) (Sweden), Rocca, B., (Co-Chairperson) (Italy), Hansson, E. C., (Sweden), ... & (Serbia). (2025). 2024 EACTS Guidelines on perioperative medication in adult cardiac surgery. European Journal of Cardio-Thoracic Surgery, 67(1), ezae355.
13. Klein, A. A., Arnold, P., Bingham, R. M., Brohi, K., Clark, R., Collis, R., ... & Walsh, T. S. (2016). AAGBI guidelines: the use of blood components and their alternatives 2016. Anaesthesia, 71(7), 829-842.
14. Klein, A. A., Collier, T., Yeates, J., et al. (2017). The ACTA-PORT score for predicting perioperative risk of blood transfusion for adult cardiac surgery. British Journal of Anaesthesia, 119, 394–401.
15. Leahy, M. F., Hofmann, A., Towler, S., et al. (2017). Improved outcomes and reduced costs associated with a health system–wide patient blood management program: A retrospective observational study in four major adult tertiary-care hospitals. Transfusion, 57, 1347–1358.
16. Murphy, G. J., Reeves, B. C., Rogers, C. A., Rizvi, S. I., Culliford, L., & Angelini, G. D. (2017). Increased mortality, postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery. Circulation, 116(22), 2544-2552.
17. Paone, G., Likosky, D. S., Brewer, R., et al. (2014). Transfusion of 1 and 2 units of red blood cells is associated with increased morbidity and mortality. The Annals of Thoracic Surgery, 97, 87–93.
18. Pavenski, K., Howell, A., Mazer, C. D., Hare, G. M., & Freedman, J. (2022). ONTraC: a 20-year history of a successfully coordinated provincewide patient blood management program: lessons learned and goals achieved. Anesthesia & Analgesia, 135(3), 448-458.
19. Saillant, N. N., Kornblith, L. Z., Moore, H., et al. (2022). The national blood shortage: An impetus for change. Annals of Surgery, 275, 641–643.
20. Santos, A. A. D., Silva, J. P. D., Silva, L. D. F. D., Sousa, A. G. D., Piotto, R. F., & Baumgratz, J. F. (2014). Therapeutic options to minimize allogeneic blood transfusions and their adverse effects in cardiac surgery: a systematic review. Brazilian Journal of Cardiovascular Surgery, 29, 606-621.
21. Shander, A., Hardy, J. F., Ozawa, S., et al. (2022). A global definition of patient blood management. Anesthesia & Analgesia, 135, 476–488.
22. Tibi, P., McClure, R. S., Huang, J., et al. (2021). STS/SCA/AmSECT/SABM update to the clinical practice guidelines on patient blood management. Journal of Cardiothoracic and Vascular Anesthesia, 35, 2569–2591.
23. Warner, M. A., Ferreira, R., Raphael, J., Shore-Lesserson, L., Grant, M. C., Hill, S. S., ... & Guinn, N. R. (2022). Return on investment of preoperative anemia management programs in cardiac surgery: an advisory from the Society of Cardiovascular Anesthesiologists Clinical Practice Improvement Committee with endorsement by the Society for the Advancement of Patient Blood Management. Anesthesia & Analgesia, 10-1213.
24. World Health Organization. (2025). The urgent need to implement patient blood management: Policy brief. https://apps.who.int/iris/bitstream/handle/10665/346655/9789240035744-eng.pdf