German Patient Blood Management Network: effectiveness and safety analysis in 1.2 million patients

被引：23

作者：

Meybohm, Patrick ^{[1
,2
]}

Schmitt, Elke ^{[1
,3
]}

Choorapoikayil, Suma ^{[1
]}

Hof, Lotta ^{[1
]}

Old, Oliver ^{[1
]}

Mueller, Markus M. ^{[4
,5
]}

Geisen, Christof ^{[5
]}

Seifried, Erhard ^{[5
]}

Baumhove, Olaf ^{[6
]}

van Weenen, Samuel de Leeuw ^{[6
]}

Bayer, Alexandra ^{[7
]}

Friederich, Patrick ^{[8
]}

Braeutigam, Brigitte ^{[9
]}

Friedrich, Jens ^{[10
]}

Gruenewald, Matthias ^{[11
]}

Elke, Gunnar ^{[10
,11
]}

Molter, Gerd P.

Narita, Diana ^{[12
]}

Raadts, Ansgar ^{[13
]}

Haas, Christoph ^{[14
]}

Schwendner, Klaus ^{[15
]}

Steinbicker, Andrea U. ^{[1
,16
]}

Jenke, Dana J. ^{[16
]}

Thoma, Josef ^{[17
]}

Weber, Viola ^{[17
]}

Velten, Markus ^{[18
]}

Wittmann, Maria ^{[18
]}

Weigt, Henry ^{[19
]}

Lange, Bjoern ^{[19
]}

Herrmann, Eva ^{[3
]}

Zacharowski, Kai ^{[1
]}

机构：

[1] Goethe Univ, Univ Hosp Frankfurt, Dept Anaesthesiol Intens Care Med & Pain Therapy, Frankfurt, Germany

[2] Univ Hosp Wurzburg, Dept Anaesthesiol Intens Care Emergency & Pain Me, Wurzburg, Germany

[3] Goethe Univ, Inst Biostat & Math Modelling, Dept Med, Frankfurt, Germany

[4] German Red Cross Blood Transfus Serv Baden Wuertt, Inst Transfus Med & Immunohaematol, Kassel, Germany

[5] German Red Cross Blood Transfus Serv Baden Wuertt, Inst Transfus Med & Immunohaematol, Frankfurt, Germany

[6] Klinikum Westmuensterland, Dept Anaesthesiol Intens Care Med & Pain Therapy, Bocholt, Germany

[7] Agatharied Hosp, Dept Anaesthesiol & Intens Care Med, Hausham, Germany

[8] Muenchen Klin, Dept Anaesthesiol Operat Intens Care Med & Pain T, Munich, Germany

[9] Muenchen Klin, Dept Finance, Cent Controlling, Munich, Germany

[10] Klinikum Leverkusen, Dept Anaesthesiol & Intens Care Med, Leverkusen, Germany

[11] Univ Med Ctr Schleswig Holstein, Dept Anaesthesiol & Operat Intens Care Med, Kiel, Germany

[12] Donauisar Klinikum, Inst Lab Diagnost & Transfus Med, Deggendorf, Germany

[13] Univ Hosp Jena, Dept Anaesthesiol & Intens Care Med, Jena, Germany

[14] Univ Hosp Jena, Execut Dept Struct Proc & Qual Management, Jena, Germany

[15] Diakonie Hosp Martha Maria, Dept Anaesthesiol & Operat Intens Care Med, Nurnberg, Germany

[16] Univ Hosp Muenster, Dept Anaesthesiol Intens Care & Pain Med, Munster, Germany

[17] Ortenau Klinikum, Dept Anaesthesiol & Operat Intens Care Med, Kehl, Germany

[18] Univ Hosp Bonn, Dept Anaesthesiol & Operat Intens Care Med, Bonn, Germany

[19] SLK Kliniken, Dept Anaesthesiol, Heilbronn, Germany

来源：

BRITISH JOURNAL OF ANAESTHESIA | 2023年 / 131卷 / 03期

关键词：

anaemia; blood transfusion; clinical outcome; patient blood management; patient safety; perioperative care; red blood cell; PREOPERATIVE ANEMIA; NONCARDIAC SURGERY; TRANSFUSIONS;

D O I：

10.1016/j.bja.2023.05.006

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

Background: Patient Blood Management (PBM) is a patient-centred, systematic, evidence-based approach to improve patient outcomes by managing and preserving a patient's own blood whilst promoting patient safety and empowerment. The effectiveness and safety of PBM over a longer period have not yet been investigated.Methods: We performed a prospectively designed, multicentre follow-up study with non-inferiority design. Data were retrospectively extracted case-based from electronic hospital information systems. All in-hospital patients (=18 yr) undergoing surgery and discharged between January 1, 2010 and December 31, 2019 were included in the analysis. The PBM programme focused on three domains: preoperative optimisation of haemoglobin concentrations, blood-sparing techniques, and guideline adherence/standardisation of allogeneic blood product transfusions. The outcomes were utilisation of blood products, composite endpoint of in-hospital mortality and postoperative complications (myocardial infarction/ischaemic stroke/acute renal failure with renal replacement therapy/sepsis/pneumonia), anaemia rate at admission and discharge, and hospital length of stay.Results: A total of 1 201 817 (pre-PBM: n=441 082 vs PBM: n=760 735) patients from 14 (five university/nine non-university) hospitals were analysed. Implementation of PBM resulted in a substantial reduction of red blood cell utilisation. The mean number of red blood cell units transfused per 1000 patients was 547 in the PBM cohort vs 635 in the pre-PBM cohort (relative reduction of 13.9%). The red blood cell transfusion rate was significantly lower (P<0.001) with odds ratio 0.86 (0.85-0.87). The composite endpoint was 5.8% in the PBM vs 5.6% in the pre-PBM cohort. The non-inferiority aim (safety of PBM) was achieved (P<0.001).Conclusions: Analysis of >1 million surgical patients showed that the non-inferiority condition (safety of Patient Blood Management) was fulfilled, and PBM was superior with respect to red blood cell transfusion.

引用

页码：472 / 481

页数：10

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