Patient Blood Management Efficiency in Patients Subject to Orthopedic and Oncologic Elective Surgery
Author(s)
Anunciação Ruivo, MD1, Teresa Campos, MD1, André Silva, MD1, Alvaro Gonçalves, MD1, Jorge Alves, MD1, Nuno Teixeira, MD1, Jorge Felix Parreia, MSc2, Valeska Andreozzi, PhD3.
1Unidade Local de Saúde do Tâmega e Sousa, Penafiel, Portugal, 2Director, Exigo Consultores LDA, Lisboa, Portugal, 3Exigo Consultores, Lisbon, Portugal.
1Unidade Local de Saúde do Tâmega e Sousa, Penafiel, Portugal, 2Director, Exigo Consultores LDA, Lisboa, Portugal, 3Exigo Consultores, Lisbon, Portugal.
OBJECTIVES: Patient Blood Management (PBM) is a multidisciplinary patient-centred strategy aiming the optimization of blood products and improving patients' outcomes. Our objective was to assess the impact of a PBM program before, during, and after the implementation of PBM at our tertiary hospital using real-world data (RWD).
METHODS: Deterministic data linkage algorithms allowed the integration of patient level data from hospital (inpatient, diagnosis related groups, blood diagnostics, PBM patient journey) and nationwide (blood products use and transfusions) databases. Outcome measures were anemia correction, red blood cells (RBC) transfusion, length of hospital stay (LOS), in-hospital mortality and infections. PBM impact was compared and assessed post versus pre-PBM implementation in patients referenced to PBM management (Cohort1) and in a subset of anemic versus non-anemic patients (Cohort2). Statistical analysis was performed after adequately pairing pre and post-PBM cohorts using propensity score matching based on age, gender, index disease, pre-surgical hemoglobin value and comorbidities.
RESULTS: The RWD sample was composed of patients subject to orthopedic and oncologic elective surgery in pre-PBM (2016-2018, n=1,543) and post-PBM (2019-2024, n=1,995) periods. With PBM intervention, in Cohort1 we observed a higher likelihood of anemia correction (hazard ratio [HR]=3.2, 95%CI: 1.9-5.4), a 26% RBC transfusion risk reduction (rate ratio=0.74, 95%CI: 0.58-0.94) and 52% reduction in the risk of in-hospital infections (risk ratio =0.48, 95%CI: 0.29-0.79). In cohort2 the proportion of patients with anemia correction after PBM was significantly higher (risk ratio=2.2, 95%CI: 1.3-3.8) and the RBC transfusion rate was 25% lower (rate ratio=0.75, 95%CI: 0.58-0.96). A non-significant reduction in LOS and in-hospital mortality was observed in both cohorts in favor of the PBM intervention.
CONCLUSIONS: Patient blood management improved the outcomes of patients subject to elective surgery in our tertiary hospital and contributed to better resource management.
METHODS: Deterministic data linkage algorithms allowed the integration of patient level data from hospital (inpatient, diagnosis related groups, blood diagnostics, PBM patient journey) and nationwide (blood products use and transfusions) databases. Outcome measures were anemia correction, red blood cells (RBC) transfusion, length of hospital stay (LOS), in-hospital mortality and infections. PBM impact was compared and assessed post versus pre-PBM implementation in patients referenced to PBM management (Cohort1) and in a subset of anemic versus non-anemic patients (Cohort2). Statistical analysis was performed after adequately pairing pre and post-PBM cohorts using propensity score matching based on age, gender, index disease, pre-surgical hemoglobin value and comorbidities.
RESULTS: The RWD sample was composed of patients subject to orthopedic and oncologic elective surgery in pre-PBM (2016-2018, n=1,543) and post-PBM (2019-2024, n=1,995) periods. With PBM intervention, in Cohort1 we observed a higher likelihood of anemia correction (hazard ratio [HR]=3.2, 95%CI: 1.9-5.4), a 26% RBC transfusion risk reduction (rate ratio=0.74, 95%CI: 0.58-0.94) and 52% reduction in the risk of in-hospital infections (risk ratio =0.48, 95%CI: 0.29-0.79). In cohort2 the proportion of patients with anemia correction after PBM was significantly higher (risk ratio=2.2, 95%CI: 1.3-3.8) and the RBC transfusion rate was 25% lower (rate ratio=0.75, 95%CI: 0.58-0.96). A non-significant reduction in LOS and in-hospital mortality was observed in both cohorts in favor of the PBM intervention.
CONCLUSIONS: Patient blood management improved the outcomes of patients subject to elective surgery in our tertiary hospital and contributed to better resource management.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HSD82
Topic
Clinical Outcomes, Health Service Delivery & Process of Care, Patient-Centered Research
Disease
Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)