OBJECTIVES: PBM aims to improve medical and surgical management of patients undergoing major elective surgery using techniques to manage and preserve the patient’s own blood. The objective is to compare the length of hospital stay (LOHS) before vs. after the implementation of PBM in Humanitas Research Hospital of Milano, Italy.

METHODS: Observational retrospective study including adult patients who underwent major planned surgeries (hip or knee replacement). Two study cohorts were defined, including surgeries before and after PBM implementation in 2013: pre-PBM cohort including all patients with surgery between 2010 and 2012; and post-PBM cohort including all patients with surgery between 2014 and 2016. Data collection was divided in three periods: pre-surgery period, up to 3 months prior to surgery; day of surgery; and post-surgery period, from day of surgery to 30 days after hospital discharge or death. Demographics, surgery data, iron deficiency anaemia treatments received, red blood cells transfusions, LOHS and other clinical outcomes were collected.

RESULTS: 7,972 surgeries were included (3,267 pre-PBM and 4,705 post-PBM), 1,534 patients with knee replacement and 6,438 with hip replacement. Mean age at surgery was 64.1 years (63.4 pre-PBM, 64.5 post-PBM); 56.8% were female (59.0% pre-PBM, 55.2% post-PBM). Mean time surgery duration was 1.1 and 1.2 hours in pre- and post-PBM cohorts. The use of ferric carboxymaltose prior to the surgery was observed in the post-PBM period (13.0% of patients). During the pre-PBM period patients were hospitalized for a mean (SD) of 16.9 (2.9) days, duration reduced to 13.7 (3.6) days during the post-PBM period (p<0.0001). When analyzing by type of surgery: knee replacement (17.2 (3.4) days to 13.0 (3.8) days, p<0.0001) and hip replacement (16.8 (2.7) days to 13.8 (3.5) days, p<0.0001).

CONCLUSIONS: This study shows the significant impact of PBM on the reduction of length of hospital stay following major orthopedic surgery.