OBJECTIVES: PBM is a patient-centered approach that addresses iron deficiency, anaemia, coagulopathy, and blood loss, in surgical and nonsurgical patients, as risk factors for adverse medical outcomes. The objective is to assess the impact of PBM implementation on red blood cells (RBC) transfusion rate and length of hospital stay (LOHS).

METHODS: Observational retrospective study including adult patients who underwent major planned surgeries (hip or knee replacement) in St Vincentius Kliniken, Karlsruhe, Germany. Two study cohorts were defined, including surgeries during a 3-year period, before and after PBM implementation in 2012: pre-PBM cohort (2009-2011) and post-PBM cohort (2013-2015). Data was collected up to 3 months prior to surgery (pre-surgery period), day of surgery and for post-surgery period (30 days after hospital discharge or death). Data collected included demographics, surgery data, iron deficiency anaemia (IDA) treatments received, red blood cells (RBC) transfusions, LOHS and other clinical outcomes.

RESULTS: 6,456 surgeries were included (3,236 pre-PBM and 3,220 post-PBM), 2,732 patients with knee replacement and 3,724 with hip replacement. Mean age at surgery was 71.1 years (70.8 pre-PBM, 71.4 post-PBM); 71.0% were female (78.0% pre-PBM, 64.0% post-PBM). The transfusion rate at post-surgery period was 60.0% for pre-PBM and 46.9% for post-PBM patients (p<0.0001); when including all data collection periods (pre- and post-surgery, including day of surgery) it was 66.6% and 51.1% (p<0.0001), respectively. The implementation of PBM was associated with a lower perioperative transfusion rate [OR of 0.47 (CI 95%: 0.43-0.53)], after adjusting for confounders. LOHS was also reduced after PBM implementation from a mean (SD) of 13.8 (6.2) days to 12.6 (5.5) (p<0.0001), reduction observed in both types of surgeries (p<0.0001).

CONCLUSIONS: The implementation of PBM program has been associated with a reduction of perioperative RBC transfusion rate and the LOHS after surgery.