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Impact of an Obstetric Hemorrhage Protocol on Post-operative Patient Outcomes in a Tertiary Care Medical Center
Abstract Number: F-31
Abstract Type: Original Research
We previously reported that implementation of an obstetric hemorrhage protocol (OHP) was associated with a lower RBC:plasma ratio, and improved post-resuscitation coagulation markers and laboratory monitoring. However, the impact of OHP on short-term patient outcomes has not been well described. We conducted a secondary data analysis to examine the impact of this OHP, implemented in November 2010, on duration of post-operative invasive positive pressure ventilation (IPPV), length of intensive care unit (ICU) admission, and time to hospital discharge following surgery (LOS).
We included patients that delivered at our institution between January 1, 2003 and September 26, 2012 and were transfused ≥ 1 unit of packed red blood cells (PRBC) intraoperatively. Data was collected on patient demographics, PRBC units transfused, pre-operative hemoglobin (Hb), need for and duration of IPPV, duration of ICU admission and LOS. We further subdivided our patient population into severe hemorrhage vs. less severe hemorrhage based on whether they died, received 4 or more units PRBCs, underwent hysterectomy, embolization, or Bakri balloon placement.
Data were summarized as mean (SD), median (25th, 75th quartiles) and number (%) and were compared pre- and post-protocol using the t-test, Wilcoxon-Rank Sum test or chi-squared test. Using multiple linear regression, we estimated the effect of OHP on LOS while adjusting for preoperative Hb, date of surgery, PRBCs units transfused and severity of hemorrhage.
122 patients met inclusion criteria (75 pre-protocol, 47 post-protocol). Overall there were no significant differences in patient demographics, ICU admission, need for IPPV, duration of IPPV or length of ICU stay for patients managed pre- and post-protocol (Table). However, patients managed post-protocol had a significantly shorter LOS (p = 0.02) (Table). In the severe hemorrhage group (n=61), there were no significant differences in outcome measures pre- vs. post-protocol (Table). However, in the less severe hemorrhage group (n=61), there was a statistically significant shorter LOS post-protocol (p = 0.004) (Table). The shorter LOS post-protocol was still observed after adjusting for severity of hemorrhage and the other covariates (p=0.0125).
Shortened LOS was seen in less severe obstetric hemorrhages after OHP implementation. There were no observed differences in other short-term outcomes, particularly in those with severe hemorrhage.