Patient Blood Management improves outcome in oncologic surgery

Abstract

BackgroundPatient Blood Management (PBM) is a systematic quality improving clinical model to reduce anemia and avoid transfusions in all kinds of clinical settings. Here, we investigated the potential of PBM in oncologic surgery and hypothesized that PBM improves 2-year overall survival (OS).MethodsRetrospective analysis of patients 2 years before and after PBM implementation. The primary endpoint was OS at 2 years after surgery. We identified a sample size of 824 to detect a 10% improvement in survival in the PBM group.ResultsThe analysis comprised of 836 patients that underwent oncologic surgery, 389 before and 447 after PBM, was implemented. Patients in the PBM+ presented significantly more frequent with normal hemoglobin values before surgery than PBM− (56.6 vs. 35.7%; p < 0.001). The number of transfusions was significantly reduced from 5.5 ± 11.1 to 3.0 ± 6.9 units/patient (p < 0.001); moreover, the percentage of patients being transfused during the clinic stay was significantly reduced from 62.4 to 40.9% (p < 0.001). Two-year OS was significantly better in the PBM+ and increased from 67.0 to 80.1% (p = 0.001). A normal hemoglobin value (> 12 g/dl in female and > 13 g/dl in male) before surgery (HR 0.43, 95% CI 0.29–0.65, p < 0.001) was the only independent predictive factor positively affecting survival.ConclusionsPBM is a quality improvement tool that is associated with better mid-term surgical oncologic outcome. The root cause for improvement is the increase of patients entering surgery with normal hemoglobin values.Electronic supplementary materialThe online version of this article (10.1186/s12957-018-1456-9) contains supplementary material, which is available to authorized users.

MicroRNA Profiling of Exosomes Derived from Red Blood Cell Units: Implications in Transfusion-Related Immunomodulation

“…With the development of new medical technology, like neoadjuvant chemoradiotherapy, the possibility of allogeneic RBC transfusion is increasing [17]. Allogeneic RBC transfusion can improve the outcome in recipients by establishing blood volume, improving blood perfusion, and changing the gut microbiome [2,[18][19][20][21][22][23][24][25]. However, allogeneic RBC transfusion can also expose recipients to a chance of immunosuppression or poor survival.…”

Programmes for the management of preoperative anaemia: audit in ten European hospitals within the PaBloE (Patient Blood Management in Europe) Working Group

“…The concept comprises more than 100 individual measures, which form the three sustaining pillars of PBM: (1) management of preoperative anaemia, (2) minimization of blood loss and (3) the rational use of allogenic blood products . It has been repeatedly demonstrated that the implementation of PBM into clinical routine reduces anaemia and transfusion rates, length of hospital stay, morbidity and mortality . Anaemia, defined by the World Health Organization (WHO) as a haemoglobin (Hb) level <12 g/dl in women and <13 g/dl in men , is a major predictor for higher perioperative transfusion requirements, prolonged length of stay in hospital and morbidity .…”

Patient blood management (PBM) in pregnancy and childbirth: literature review and expert opinion

“…It comprises a series of measures and methods to maintain an optimal haemoglobin (Hb) level, optimise haemostasis, minimise blood loss, and limit blood transfusions aiming to improve patient outcomes. Recent studies have shown that the use of PBM minimizes perioperative bleeding, reduces the requirement of blood transfusion [1][2][3][4][5][6][7][8], perioperative morbidity [1][2][3][4], mortality, duration of hospitalization [1,4], and costs [9,10]. Regarding this, the World Health Organization (WHO) was recommending since 2010 to urgently implement PBM [11].…”

“…Regarding this, the World Health Organization (WHO) was recommending since 2010 to urgently implement PBM [11]. Some hospitals have already successfully implemented PBM notably in Australia [7], Europe [2,[4][5][6], United States [3], and also in Asia. However, many obstetricians and obstetrical departments still are in need of guidance for the implementation of PBM in daily clinical practice.…”