Implementation of a Blood Management Program at a Tertiary Care Hospital Effect on Transfusion Practices and Clinical Outcomes Among Patients Undergoing Surgery
Implementation of a Blood Management Program at a Tertiary Care Hospital Effect on Transfusion Practices and Clinical Outcomes Among Patients Undergoing Surgery
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DOI：
10.1097/sla.0000000000002585
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发表时间：
2019-06-01
影响因子：
9
通讯作者：
Pawlik, Timothy M.
中科院分区：
文献类型：
--
作者：
Gani, Faiz;Cerullo, Marcelo;Pawlik, Timothy M.
背景：患者血液管理 (PBM) 计划代表了一系列围手术期护理，旨在减少或消除不必要的输血。目的：评估 PBM 计划对美国三级护理医院单个外科部门的输血实践和临床结果的影响。方法：这项事前、事后横断面研究使用 2010 年至 2013 年间接受胃肠手术的 17,114 名患者的数据进行。采用多变量回归分析评估实施 PBM 计划对输血实践和围手术期临床结果的影响。 结果：实施 PBM 计划与使用自由触发血红蛋白浓度（PBM 前与 PBM 后：触发 >= 8.0 g/dL：20.2% vs 15.3%，P < 0.001）接受浓缩红细胞 (PRBC) 的患者比例减少相关，以及接受 PRBC 的患者比例增加相关使用限制性触发血红蛋白浓度（触发 0.05）。结论：实施 PBM 计划与使用自由触发血红蛋白浓度接受 PRBC 输血的患者减少以及“过度输血”患者减少相关，且住院时间、发病率或死亡率没有任何可检测到的变化。PBM 计划可以在各医院安全实施，并应用于提高质量和减少不必要的输血。
Background: Patient blood management (PBM) programs represent a perioperative bundle of care that aim to reduce or eliminate unnecessary transfusions.Objective: To evaluate the impact of a PBM program on transfusion practices and clinical outcomes at a single surgical department at a tertiary care hospital in the United States.Methods: This pre-post, cross-sectional study was performed using data from 17,114 patients undergoing gastrointestinal surgery between 2010 and 2013. Multivariable regression analysis was used to evaluate the impact of implementing a PBM program on transfusion practices and perioperative clinical outcomes.Results: Implementation of the PBM program was associated with a reduction in the proportion of patients receiving packed red blood cell (PRBC) using a liberal trigger hemoglobin concentration (pre-PBM vs post-PBM: trigger >= 8.0 g/dL: 20.2% vs 15.3%, P < 0.001), as well as an increase in the proportion of patients receiving PRBC using a restrictive trigger hemoglobin concentration (trigger 0.05).Conclusions: Implementation of a PBM program was associated with fewer patients receiving PRBC transfusion using a liberal trigger hemoglobin concentration and fewer patients being "overtransfused,'' without any detectable change in length-of-stay, morbidity or mortality. PBM programs can be safely implemented across hospitals and should be used to improve quality and reduce unnecessary transfusions.