Thrombelastography-Directed Transfusion in Cardiac Surgery: Impact on Postoperative Outcomes

Background: Transfusion of allogenic blood products is associated with substantial morbidity and increased risk of mortality. Thrombelastography (TEG) to direct transfusion management during and immediately after cardiothoracic surgery reduced blood product usage in our institution. The goal of this study was to quantify the impact of TEG on postoperative outcomes.

Methods: All patients who underwent cardiac surgical procedures before and after implementation of TEG were retrospectively analyzed. Baseline patient characteristics, blood product administration, and length of stay (LOS) were compared. A logistic regression model was used to evaluate the impact of TEG on the odds of reoperation, LOS, and 6-month mortality.

Results: Included in analysis were 367 patients in the pre-TEG period and 310 patients in the post-TEG period. Baseline characteristics did not vary between periods. Exposure to blood products was significantly reduced after implementation of TEG (p < 0.001). The incidence of reoperation was lower in the post-TEG period (7.1% versus 3.5%, p = 0.04). Controlling for related factors on multivariate analysis, TEG was associated with reduction in postoperative LOS (11.3 versus 9.9 days, p = 0.04) and 6-month mortality (odds ratio 2.98, 95% confidence limits: 1.13 and 7.85).

Conclusions: The use of TEG to guide blood product administration substantially affected patient outcomes, including LOS, odds of reoperation, and short-term mortality. The impacts appreciated may be due to the reduced use of allogenic blood products and the ability to distinguish between postoperative coagulopathy and surgical bleeding with the use of this point-of-care test.