Reduction of Transfusion Requirements and Length of Hospital Stay in Patients Undergoing Major Planned Surgery After the Implementation of Patient Blood Management (PBM) in Spain
Author(s)
Colomina MJ1, De La Fuente Graciani I2, Pereda-Manso A2, Barquero M1, Mendez E1, Ramirez de Arellano Serna A3, Morin N4, Lara N5, Illa C6, Roset M6, Ruiz N2
1Hospital Universitario Bellvitge, Barcelona, Spain, 2Hospital Clínico Universitario de Valladolid, Valladolid, Spain, 3Vifor Pharma Group, Glattbrugg, ZH, Switzerland, 4Vifor Pharma Group, Glattbrugg , ZH, Switzerland, 5IQVIA, BARCELONA, B, Spain, 6IQVIA, Barcelona, Spain
Presentation Documents
OBJECTIVES: PBM is a program including a set of evidence-based practices to optimize patient outcomes clinically managing and preserving the patient’s own blood. The objective is to compare the transfusion rate and length of hospital stay (LOHS) before vs. after PBM implementation.
METHODS: Retrospective study including adult patients who underwent major planned surgeries (hip or knee replacement, major abdominal surgery, and cardiac valve) in two Spanish hospitals (Bellvitge University, Barcelona, and Valladolid University Clinical Hospital). Two study cohorts were defined, pre-PBM including all surgeries performed during three years period before PBM implementation, and post-PBM including all surgeries performed during three years period after PBM implementation. 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). Demographics, surgery data, iron deficiency anaemia (IDA) treatments received, red blood cells (RBC) transfusions, LOHS and other clinical outcomes were collected.
RESULTS: 8,080 surgeries included (3,780 pre-PBM and 4,300 post-PBM). Mean age at surgery was 70.5 years (70.4 pre-PBM, 70.6 post-PBM); 53.6% were female (54.8% pre-PBM, 52.5% post-PBM). Prior to surgery, to treat anemia, in pre-PBM cohort 0.2% of patients received IV iron, whereas in the post-PBM cohort 2.7% of patients received IV iron in the form of ferric carboxymaltose. The transfusion rate including all data collection periods (pre- and post-surgery, including day of surgery) was 46.7% in pre-PBM cohort and 37.6% in post-PBM cohort (p<0.0001). The implementation of PBM was associated with a lower perioperative RBC transfusion rate [OR: 0.68 (CI 95%: 0.63-0.75)], after adjusting for confounders. LOHS was also reduced after PBM implementation from a mean (SD) of 13.6 (13.6) days to 11.6 (12.1) days (p<0.0001).
CONCLUSIONS: Implementation of PBM was associated to a significant reduction of perioperative RBC transfusion rate and the LOHS after surgery.
Conference/Value in Health Info
Value in Health, Volume 25, Issue 12S (December 2022)
Code
CO83
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy, Performance-based Outcomes
Disease
STA: Surgery