J Faulds1, C Whately-Smith2, K Clarke3. 1. Patient Blood Management, Royal Cornwall Hospital NHS Trust, Cornwall, UK. 2. Whately-Smith Ltd, King's Langley, UK. 3. Department of Haematology, Royal Cornwall Hospital NHS Trust, Cornwall, UK.
Abstract
OBJECTIVE: To assess the value of patient blood management (PBM) in the detection and management of preoperative anaemia before elective surgery. BACKGROUND: PBM is recognised as the standard of care, with diagnosis and management of preoperative anaemia being the key components of PBM. No formal assessment of the value of PBM anaemia screening and correction before scheduled surgery had been made at our hospital. METHODS: We conducted a retrospective study in a tertiary-care, academic hospital of consecutive records of elective surgery (n = 25 641). We excluded minor surgeries. We identified anaemic patients who had been assessed by PBM or not (non-PBM). We calculated transfusion incidence and hospital length of stay (LOS) across all surgical specialities. RESULTS: During the 1-year study period, 15 245 patients were eligible for inclusion; 311 patients (2·0%) were transfused, and 83·3% of transfusions were in anaemic patients. Transfusion incidence was 9·2% in anaemic PBM-assessed patients and 17·4% in non-PBM patients. For haemoglobin (Hb) <100 g L-1 , the transfusion incidence was 22·1% [95% confidence interval (CI) 15·5-30·6%] in PBM and 40·0% (95% CI 35·1-45·0%) in non-PBM patients, and for Hb 100-119 g L-1 , it was 4·7% (95% CI 2·8-7·5%) and 7·9% (95% CI 6·3-9·8%), respectively. Overall mean LOS was 2·1 days [standard deviation (SD) 6·0]. Mean LOS with Hb <100 g L-1 was 6·7 days (SD 14·8) in PBM-assessed patients and 12·4 days (SD 19·5) in non-PBM patients and was 3·1 (SD 5·2) and 6·2 (SD 9·5) days, respectively, for Hb 100-119 g L-1 . CONCLUSION: Anaemic elective surgery patients assessed by patient blood management (PBM) had a markedly lower transfusion risk and shorter LOS than anaemic patients not assessed by PBM.
OBJECTIVE: To assess the value of patient blood management (PBM) in the detection and management of preoperative anaemia before elective surgery. BACKGROUND:PBM is recognised as the standard of care, with diagnosis and management of preoperative anaemia being the key components of PBM. No formal assessment of the value of PBManaemia screening and correction before scheduled surgery had been made at our hospital. METHODS: We conducted a retrospective study in a tertiary-care, academic hospital of consecutive records of elective surgery (n = 25 641). We excluded minor surgeries. We identified anaemic patients who had been assessed by PBM or not (non-PBM). We calculated transfusion incidence and hospital length of stay (LOS) across all surgical specialities. RESULTS: During the 1-year study period, 15 245 patients were eligible for inclusion; 311 patients (2·0%) were transfused, and 83·3% of transfusions were in anaemic patients. Transfusion incidence was 9·2% in anaemic PBM-assessed patients and 17·4% in non-PBMpatients. For haemoglobin (Hb) <100 g L-1 , the transfusion incidence was 22·1% [95% confidence interval (CI) 15·5-30·6%] in PBM and 40·0% (95% CI 35·1-45·0%) in non-PBMpatients, and for Hb 100-119 g L-1 , it was 4·7% (95% CI 2·8-7·5%) and 7·9% (95% CI 6·3-9·8%), respectively. Overall mean LOS was 2·1 days [standard deviation (SD) 6·0]. Mean LOS with Hb <100 g L-1 was 6·7 days (SD 14·8) in PBM-assessed patients and 12·4 days (SD 19·5) in non-PBMpatients and was 3·1 (SD 5·2) and 6·2 (SD 9·5) days, respectively, for Hb 100-119 g L-1 . CONCLUSION: Anaemic elective surgery patients assessed by patient blood management (PBM) had a markedly lower transfusion risk and shorter LOS than anaemic patients not assessed by PBM.
Authors: Toby Richards; Ravishankar Rao Baikady; Ben Clevenger; Anna Butcher; Sandy Abeysiri; Marisa Chau; Rebecca Swinson; Tim Collier; Matthew Dodd; Laura Van Dyck; Iain Macdougall; Gavin Murphy; John Browne; Andrew Bradbury; Andrew Klein Journal: Health Technol Assess Date: 2021-02 Impact factor: 4.014