BACKGROUND: Patient blood management (PBM) programs represent a perioperative bundle of care that aim to reduce or eliminate unnecessary transfusions. OBJECTIVE: To evaluate the impact of a PBM program on transfusion practices and clinical outcomes at a single surgical department at a tertiary care hospital in the United States. METHODS: This pre-post, cross-sectional study was performed using data from 17,114 patients undergoing gastrointestinal surgery between 2010 and 2013. Multivariable regression analysis was used to evaluate the impact of implementing a PBM program on transfusion practices and perioperative clinical outcomes. RESULTS: Implementation of the PBM program was associated with a reduction in the proportion of patients receiving packed red blood cell (PRBC) using a liberal trigger hemoglobin concentration (pre-PBM vs post-PBM: trigger ≥8.0 g/dL: 20.2% vs 15.3%, P < 0.001), as well as an increase in the proportion of patients receiving PRBC using a restrictive trigger hemoglobin concentration (trigger <7.0 g/dL: 37.1% vs 46.4%, P < 0.001). The proportion of patients overtransfused to a target hemoglobin concentration of 9.0 g/dL (54.8% vs 43.9%, P < 0.001) or 10.0 g/dL (22.3% vs 15.8%, P < 0.001) also decreased following implementation of the PBM program. On multivariable analysis, implementation of the PBM program was associated with 23% lower odds of receiving PRBC transfusion (odds ratio = 0.77, 95% confidence interval 0.657-0.896, P = 0.001); hospital length-of-stay, postoperative morbidity, and postoperative mortality were unchanged (all P > 0.05). CONCLUSIONS: Implementation of a PBM program was associated with fewer patients receiving PRBC transfusion using a liberal trigger hemoglobin concentration and fewer patients being "overtransfused," without any detectable change in length-of-stay, morbidity or mortality. PBM programs can be safely implemented across hospitals and should be used to improve quality and reduce unnecessary transfusions.
BACKGROUND:Patient blood management (PBM) programs represent a perioperative bundle of care that aim to reduce or eliminate unnecessary transfusions. OBJECTIVE: To evaluate the impact of a PBM program on transfusion practices and clinical outcomes at a single surgical department at a tertiary care hospital in the United States. METHODS: This pre-post, cross-sectional study was performed using data from 17,114 patients undergoing gastrointestinal surgery between 2010 and 2013. Multivariable regression analysis was used to evaluate the impact of implementing a PBM program on transfusion practices and perioperative clinical outcomes. RESULTS: Implementation of the PBM program was associated with a reduction in the proportion of patients receiving packed red blood cell (PRBC) using a liberal trigger hemoglobin concentration (pre-PBM vs post-PBM: trigger ≥8.0 g/dL: 20.2% vs 15.3%, P < 0.001), as well as an increase in the proportion of patients receiving PRBC using a restrictive trigger hemoglobin concentration (trigger <7.0 g/dL: 37.1% vs 46.4%, P < 0.001). The proportion of patients overtransfused to a target hemoglobin concentration of 9.0 g/dL (54.8% vs 43.9%, P < 0.001) or 10.0 g/dL (22.3% vs 15.8%, P < 0.001) also decreased following implementation of the PBM program. On multivariable analysis, implementation of the PBM program was associated with 23% lower odds of receiving PRBC transfusion (odds ratio = 0.77, 95% confidence interval 0.657-0.896, P = 0.001); hospital length-of-stay, postoperative morbidity, and postoperative mortality were unchanged (all P > 0.05). CONCLUSIONS: Implementation of a PBM program was associated with fewer patients receiving PRBC transfusion using a liberal trigger hemoglobin concentration and fewer patients being "overtransfused," without any detectable change in length-of-stay, morbidity or mortality. PBM programs can be safely implemented across hospitals and should be used to improve quality and reduce unnecessary transfusions.
Authors: Matthew A Warner; Nilesh S Jambhekar; Salwa Saadeh; Eapen K Jacob; Justin D Kreuter; William C Mundell; Alberto Marquez; Andrew A Higgins; Nageswar R Madde; William J Hogan; Daryl J Kor Journal: Transfusion Date: 2019-06-20 Impact factor: 3.157
Authors: Matthew A Warner; Phillip J Schulte; Andrew C Hanson; Nageswar R Madde; Jennifer M Burt; Andrew A Higgins; Nicole M Andrijasevic; Justin D Kreuter; Eapen K Jacob; James R Stubbs; Daryl J Kor Journal: Mayo Clin Proc Date: 2021-11-01 Impact factor: 7.616
Authors: Miguel Montoro; Mercedes Cucala; Ángel Lanas; Cándido Villanueva; Antonio José Hervás; Javier Alcedo; Javier P Gisbert; Ángeles P Aisa; Luis Bujanda; Xavier Calvet; Fermín Mearin; Óscar Murcia; Pilar Canelles; Santiago García López; Carlos Martín de Argila; Montserrat Planella; Manuel Quintana; Carlos Jericó; José Antonio García Erce Journal: Front Med (Lausanne) Date: 2022-09-15
Authors: Aryeh Shander; Susan M Goobie; Matthew A Warner; Matti Aapro; Elvira Bisbe; Angel A Perez-Calatayud; Jeannie Callum; Melissa M Cushing; Wayne B Dyer; Jochen Erhard; David Faraoni; Shannon Farmer; Tatyana Fedorova; Steven M Frank; Bernd Froessler; Hans Gombotz; Irwin Gross; Nicole R Guinn; Thorsten Haas; Jeffrey Hamdorf; James P Isbister; Mazyar Javidroozi; Hongwen Ji; Young-Woo Kim; Daryl J Kor; Johann Kurz; Sigismond Lasocki; Michael F Leahy; Cheuk-Kwong Lee; Jeong Jae Lee; Vernon Louw; Jens Meier; Anna Mezzacasa; Manuel Munoz; Sherri Ozawa; Marco Pavesi; Nina Shander; Donat R Spahn; Bruce D Spiess; Jackie Thomson; Kevin Trentino; Christoph Zenger; Axel Hofmann Journal: Anesth Analg Date: 2020-07 Impact factor: 5.108