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 compare red blood cells (RBC) transfusion rates before vs. after PBM implementation in Humanitas Research Hospital of Milano, Italy.

METHODS: Observational retrospective study among adult patients who underwent major planned surgeries (hip or knee replacement) with two cohorts: 1) patients who received surgery during the three years (2010-2012) prior PBM program use (pre-PBM cohort); 2) patients who received surgery after PBM implementation (2014-2016) (post-PBM cohort). 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 treatments received, RBC transfusions and other clinical outcomes.

RESULTS: 7,972 surgeries included (3,267 pre-PBM and 4,705 post-PBM). 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. During surgery pre-PBM period patients lost a mean of 176.5 mL of blood and post-PBM patients 207.3 mL. Transfusion rate at post-surgery period was 20.0% for pre-PBM and 8.5% for post-PBM patients (p<0.0001); being 24.3% and 13.8% (p<0.0001), respectively, for all data collection surgery periods (day of surgery inclusive). PBM implementation was associated with a lower perioperative transfusion rate [OR of 0.43 (CI 95%: 0.38-0.49)], after adjusting for confounders. In addition, the use of ferric carboxymaltose prior to surgery (received by 13% of post-PBM patients) was also associated with a lower perioperative transfusion rate (OR=0.29, 95% CI: 0.22-0.39).

CONCLUSIONS: PBM, and specifically the use of ferric carboxymaltose pre-surgery, has a significant impact on the reduction of perioperative RBC transfusion rate.