Peek behind the paper: reducing preoperative blood orders and costs for radical prostatectomy

Peek behind the paper with study authors Natasha Gupta and Mereze Visagie (both at Johns Hopkins University School of Medicine; MD, USA) to evaluate the impacts of a maximum surgical blood order schedule (MSBOS) on preoperative blood orders and procedure-related costs for radical prostatectomies.

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Radical prostatectomies are common urological procedures performed as part of the treatment and/or management of prostate cancer. Research has demonstrated that costs associated with radical prostatectomies can vary significantly across healthcare centers in the USA, based on various patient, surgeon and hospital factors.

To improve efficiency, it is important to identify areas within the radical prostatectomy procedure pathway where value can be optimized; preoperative blood ordering represents a potential area for improvement as both open and robot-assisted laparoscopic radical prostatectomies have been associated with relatively low transfusion rates.

We hope our research will motivate a reduction in unnecessary preoperative blood preparation and associated costs for common procedures, such as radical prostatectomies."

In 2012, to promote efficient preoperative blood preparation and reduce the potential wastage of blood, an updated maximum surgical blood order schedule (MSBOS) was devised and implemented at Johns Hopkins University School of Medicine (MD, USA).

In recent research, Natasha Gupta, Mereze Visagie (both Johns Hopkins University School of Medicine) and collaborators assessed temporal trends in preoperative blood ordering practices before and after MSBOS implementation, quantifying protocol compliance and associated costs.

Read the research article in the Journal of Comparative Effectiveness Research now>>

In this feature, peek behind the paper with lead and contributing study authors Gupta and Visagie to gain further insight on the impacts of a maximum surgical blood order schedule on preoperative blood orders and procedure-related costs for radical prostatectomies.


Please could you introduce yourselves?

Visagie (MV): At the time of conducting this study, I was a data manager and research assistant to Steve Frank, the Director of both the Johns Hopkins Health System Blood Management Program, and the Bloodless Medicine and Surgery Program at Johns Hopkins Hospital.

Gupta (NG): I am a fifth year resident in urological surgery at the Brady Urological Institute at the Johns Hopkins University School of Medicine.


What prompted you to conduct this research?

MV and NG: We were interested in conducting this inter-departmental project to see whether our data-driven, MSBOS effectively reduced unnecessary preoperative blood orders and procedure-related costs for radical prostatectomies, as  this represents one of the most common urologic procedures at our institution.


What are some of the challenges associated with conducting retrospective analyses and what limitations may these impose on the results of your study?

MV: As with any retrospective study, we can only comment on associations between variables, not causation. This study also required a collaboration between Urology and Anesthesiology and Critical Care Departments at Johns Hopkins Hospital; we had to merge datasets across departments, which posed a challenge initially, but we were able to format the data to allow for a cohesive merger.


What are some of the implications of your research; how do you hope healthcare providers and practitioners may respond?

MV and NG: We hope our research will motivate a reduction in unnecessary preoperative blood preparation and associated costs for common procedures, such as radical prostatectomies.

We also hope that other institutions learn to adopt similar blood ordering guidelines – such as our MSBOS – that promote data-driven clinical decision-making.


Do you have future studies planned, for example to investigate how provider education may yield additional cost savings?

MV: One of our next steps after this study would be to evaluate how provider education could improve preoperative blood ordering compliance. With increased compliance to protocols such as the MSBOS, we would expect an improvement in value-driven care.


Disclosure:

The opinions expressed in this feature are those of the interviewees/authors and do not necessarily reflect the views of The Evidence Base® or Future Science Group.

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