Effect of a Patient Blood Management Program on the Appropriateness of Red Blood Cell Transfusion and Clinical Outcomes in Elderly Patients Undergoing Hip Fracture Surgery

Abstract

Background Elderly patients with hip fractures frequently receive perioperative transfusions, which are associated with increased morbidity and mortality. This study aimed to evaluate the impact of a patient blood management (PBM) program on the appropriateness of red blood cell (RBC) transfusion and clinical outcomes in geriatric patients undergoing hip fracture surgery. Methods In 2018, the revised PBM program was implemented at the Korea University Anam Hospital, Seoul, Republic of Korea. Elderly patients aged ≥ 65 years who underwent hip fracture surgery from 2017 to 2020 were evaluated. Clinical characteristics and outcomes were analyzed according to the timing of PBM implementation (pre-PBM, early-PBM, and late-PBM). Multiveriate regression analysis was used to evaluate the risk factors of the adverse outcomes, such as in-hospital mortality or 30-day readmission. Results A total of 884 elderly patients were included in this study. The proportion of patients who received perioperative RBC transfusions decreased significantly (43.5%, 40.1%, and 33.2% for pre-PBM, early-PBM, and late-PBM, respectively; P = 0.013). However, the appropriateness of RBC transfusion significantly increased (54.0%, 60.1%, and 94.7%, respectively; P < 0.001). The duration of in-hospital stay and 30-day readmission rates significantly decreased. Multivariable regression analysis revealed that RBC transfusion (odds ratio, 1.815; 95% confidence interval, 1.137–2.899; P = 0.013) was significantly associated with adverse outcomes. Conclusion Implementing the PBM program increased the appropriateness of RBC transfusion without compromising transfusion quality and clinical outcomes. Therefore, adopting the PBM program may improve the clinical management of elderly patients following hip fracture surgery.

Age and sex differences in blood product transfusions and mortality in trauma patients at a level I trauma center

“…Moreover, physicians may be less likely to initiate massive transfusion in patients who may have a decreased ejection fraction and would poorly tolerate volume. Nonetheless, massive transfusion protocols have been shown to effectively decrease mortality in elderly trauma patients, especially early in administration [ [24] , [25] , [26] , [27] ]. In addition, massive transfusion has been shown to improve coagulation function, alleviate organ dysfunction, and shorten the length of ICU stay in elderly populations [ 31 ].…”

“…Growing data suggests that age is not an independent risk factor for increased mortality after trauma and elderly patients who otherwise meet criteria for transfusion have better outcomes when transfused aggressively [ [24] , [25] , [26] ]. The factors that contribute to increased mortality in older trauma patients are multifactorial and more data are required to further guide clinical practice.…”

“…In a retrospective cohort analysis, older trauma patients receiving massive transfusion a 1:1 ratio of PRBCs to FFP were more likely to survive than when other transfusion ratios were used [ 21 , 24 ]. Even massive transfusions for elderly patients with multiple injuries have been shown to reduce mortality and improve outcome [ [24] , [25] , [26] ].…”

Development and validation of machine learning models to predict perioperative transfusion risk for hip fractures in the elderly

“…Although controversial, numerous studies have indicated that the use of perioperative blood products is associated with several adverse events [ 10–15 ]. Identifying patients at high risk for perioperative transfusion early in their admission and implementing patient blood management (PBM) can significantly reduce transfusion requirements [ 16 , 17 ], offering a therapeutic opportunity to avoid transfusions and enhance patient prognosis [ 18 ].…”