Point-of-care haemostasis monitoring during liver transplantation is cost effective

Abstract

Background: Optimal haemostasis management in orthotropic liver transplant (OLT) could reduce blood loss and transfusion volume, improve patient outcomes and reduce cost. Methods: We performed a study including 336 OLTs to evaluate the clinical and cost effectiveness of a new pointof- care (POC)-based haemostatic management approach in OLT patients. Results: In terms of health benefit we found that the new approach showed a significant reduction in transfusion requirements (red blood cell transfusion units were reduced from 5.3 ± 4.6 to 2.8 ± 2.9 [p < 0.001], free frozen plasma from 3.1 ± 3.3 to 0.4 ± 1.0 [p < 0.001] and platelets from 2.9 ± 3.9 to 0.4 ± 0.9 [p < 0.001], transfusion avoidance, 9.7% vs. 29.1% [p < 0.001] and massive transfusion, 14.5% vs. 3.8% [p = 0.001]); we also found a significant improvement in patient outcomes, such, reoperation for bleeding or acute-kidney-failure (8.3% vs. 2.4%, p = 0.015; 33.6% vs. 5.4%, p < 0.001), with a significant reduction in the length of the hospital total stay (40.6 ± 13.8 days vs. 38.2 ± 14.4 days, p = 0.001). The lowest cost incurred was observed with the new approach (€73,038.80 vs. €158,912.90) with significant patient saving associated to transfusion avoidance (€1278.36), ICU-stay (€3037.26), total-stay (€3800.76) and reoperation for bleeding (€80,899.64). Conclusions: POC haemostatic monitoring during OLT is cost effective.