Changes of volume substitution for the treatment of hemorrhage within 10 years and their costs.

Whereas 10 years ago blood loss was substituted by whole blood application together with colloidal or crystalloid substitutes, this behavior changed to a distinct therapy according to the changed laboratory parameters with the application of red cell concentrates together with fresh frozen plasma (FFP). By means of two representative operations (resection of sigma and hemicolectomy) the behavior of volume application and the substitution of blood and blood components were controlled for the years 1980 and compared with the behavior of 1990. In addition to that the costs for both behaviors were calculated and compared. The volume substitution of altogether 176 patients was investigated. 87 patients were operated in the year 1980 and 89 patients in the year 1990. 60% sigma resection were observed on both decades. The analysis revealed that the main substitute (60%) was whole blood in the year 1980 whereas in the year 1990 only 3% of the patients were treated with whole blood. A reverse development was observed with the application of red cell concentrates which was only 2% in the year 1980 but 54% in the year 1990. Unexpectedly the consumption of FFP remained nearly constant in both decades whereas the administration of 5% albumin increased from 40% to 80%. Also the behavior with regard to colloidal substitutes changed markedly within the 2 decades. Dextran and gelatin preparations were exclusively applied in the year 1980 and starch preparations in mainly the year 1990. This changed behavior was responsible for an increase of the costs of 100 $US for every patient. Although the changed behavior can be explained with advantages for the patient but this must be paid by an increase of the costs.