<b><i>Background:</i></b> Allogeneic blood transfusions in oncologic surgery are associated with increased recurrence and mortality. Adverse effects on outcome could be reduced or avoided by using intraoperative autologous blood cell salvage (IOCS). However, there are concerns regarding the safety of the autologous IOCS blood. Previous meta-analyses from 2012 and 2020 did not identify increased risk of cancer recurrence after using autologous IOCS blood. The objective of this review was to reassess a greater number of IOCS-treated patients to present an updated and more robust analysis of the current literature. <b><i>Methods:</i></b> This systematic review includes full-text articles listed in PubMed, Cochrane, Cochrane Reviews, and Web of Science. We analyzed publications that discussed cell salvage or autotransfusion combined with the following outcomes: cancer recurrence, mortality, survival, allogeneic transfusion rate and requirements, length of hospital stay (LOS). To rate the strength of evidence, a Grading of Recommendations Assessment, Development and Evaluation (GRADE) of the underlying evidence was applied. <b><i>Results:</i></b> In the updated meta-analysis, 7 further observational studies were added to the original 27 observational studies included in the former 2020 analysis. Studies compared either unfiltered (<i>n</i> = 2,311) or filtered (<i>n</i> = 850) IOCS (total <i>n</i> = 3,161) versus non-IOCS use (<i>n</i> = 5,342). Control patients were either treated with autologous predonated blood (<i>n</i> = 484), with allogeneic transfusion (<i>n</i> = 4,113), or did not receive a blood transfusion (<i>n</i> = 745). However, the current literature still contains only observational studies on these topics, and the strength of evidence remains low. The risk of cancer recurrence was reduced in recipients of autologous salvaged blood with or without LDF (odds ratio [OR] 0.76, 95% confidence interval [CI]: 0.64–0.90) compared to nontransfused patients or patients with allogeneic transfusion. There was no difference in mortality (OR 0.95, 95% CI: 0.71–1.27) and LOS (mean difference −0.07 days, 95% CI: −0.63 to 0.48) between patients treated with IOCS blood or those in whom IOCS was not used. Due to high heterogeneity, transfusion rates or volumes could not be analyzed. <b><i>Conclusion:</i></b> Randomized controlled trials comparing mortality and cancer recurrence rate of IOCS with or without LDF filtration versus allogeneic blood transfusion were not found. Outcome was similar or better in patients receiving IOCS during cancer surgery compared to patients with allogeneic blood transfusion or nontransfused patients.
Background and aims Germany uses more blood transfusions than the majority of other countries. The objective of this study was to detect the degree of Patient Blood Management (PBM) implementation within Germany and to identify obstacles to establishing PBM programs. Methods An electronical questionnaire containing 21 questions and 4 topics was sent in 2018 to the members of the German interdisciplinary hemotherapy (IAKH) society in Germany. The degree of PBM (described as pre‐, intra‐, postoperative period) was established via questions within the topics “management of preoperative anemia” (PA) ( n = 5), “preoperative management and transfusion preparation” ( n = 3), PBM organization and structure ( n = 5), coagulation management ( n = 3), perioperative transfusion performance and habits ( n = 3), best practices and problems ( n = 2). Results 533 German hospitals with transfusion activity received the questionnaire with a 32.5% response rate to the survey. A dedicated PBM program had not been established in a quarter of all small and medium sized institutions. Red blood cell transfusion was the only therapeutic option in a third of institutions. Approximately half of the hospitals did not use knowledge of PA rates or transfusion needs of surgical procedures. Institutions failed to implement PBM because of a lack of profit, workload, personnel shortage, and administrative support. Conclusion PBM was not present in at least a quarter of the hospitals interrogated. Factors for improvement were the relationship between health care disciplines and sectors, economic incentives, inclusion of relevant disciplines, and the structure of the blood industry. To improve BPM implementation, hospitals need support to implement top‐down PBM projects.
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