Implementation of a Blood Management Program at a Tertiary Care Hospital: Effect on Transfusion Practices and Clinical Outcomes Among Patients Undergoing Surgery. Issue 6 (June 2019)

• Record Type: Journal Article
• Authors: Gani, Faiz; Cerullo, Marcelo; Ejaz, Aslam; Gupta, Pranjal B.; Demario, Vincent M.; Johnston, Fabian M.; Frank, Steven M.; Pawlik, Timothy M.
• Is Part Of: Annals of surgery. Volume 269:Issue 6(2019)
• Publication Date: 2019-06
• Subjects: blood -- blood management -- implementation -- quality -- transfusion; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000002585
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : 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. Abstract : Supplemental Digital Content is available in the text