(1745) Implementation and Cost Analysis of a Whole Blood Program at a Community Level 1 Trauma Center

Introduction: Traumatic injury is the leading cause of death in individuals under 40 with upwards of 80% of deaths from hemorrhage. Traditionally, blood transfusion programs used component therapy (CT). As more centers implement whole blood (WB) programs, little is known about clinical outcomes or financial costs in community hospitals. We hypothesize that implementing a whole blood program improves clinical outcomes, decreases total blood product utilization, and reduces hospital costs for trauma patients who present in hemorrhagic shock.

Methods: A retrospective review (July 1, 2019-June 30, 2024) of all trauma patients who presented in hemorrhagic shock to a community Level 1 trauma center was performed. Patients who received CT with or without WB were included. 3 cohorts were examined; CT prior to WB availability, WB available in the blood bank (BB), and WB available in the trauma bay (TB). Primary outcomes were mortality and blood product cost. Secondary outcomes were intensive care unit (ICU) days, total transfusion volume, and direct hospital cost were included.

Results: 312 patients (CT:n=98, BB:n=106, and TB:n=108) met inclusion criteria. Age, mechanism of injury, ISS, and need for surgery were similar. Although mortality (CT:38.8% vs. BB:33% vs. TB:30.6%; p=0.44), median total transfusion volume at 4 hours (CT:1400mL vs. BB:1200 mL vs. TB:1000 mL; p=0.25), and ICU days (CT:5 vs. BB:4 vs. TB:3; p=0.54) decreased, none were statistically significant. Median PRBC cost per patient decreased (CT:$838.68 vs. BB:$838.68 vs. TB:$559.12; p≤0.05), however median FFP (CT:$160.84vs. BB:$80.42 vs. TB:$0; p=0.15), and median platelet (CT: $329.74vs. BB: $311.48 vs. TB: $234.16; p=0.51) were similar. Median total cost per patient was also similar (CT:$1118.24 vs. BB:$999.52 vs. TB:$919.10; p=0.87). The number of patients transfused with whole blood increased as it became more immediately available (CT:0% vs. BB:14.2%, TB:56.5%; p ≤0.05)

Conclusions: Implementation of a whole blood program at a community Level 1 trauma center led to decreased PRBC cost. Total direct cost, mortality, and total transfusion volume were similar. WB availability in the TB led to a significant increase in utilization.