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Şanal L, Günaydın S, Tatar M. Cost-Effectiveness and Budget Impact Analyses of Patient Blood Management in a Cardiovascular Surgery Department at Ankara Bilkent City Hospital in Turkey. Adv Ther 2024; 41:716-729. [PMID: 38110651 PMCID: PMC10838852 DOI: 10.1007/s12325-023-02733-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/09/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION Anemia and transfusion of blood products are risk factors associated with poor patient outcomes across all elective surgeries. Patient blood management (PBM) is a patient-centered approach to optimize patient's endogenous red cell mass, to minimize blood loss in patients undergoing surgery, and to harness and optimize patient-specific physiological tolerance to anemia. This study aimed to assess (1) the impact of PBM on blood product usage in cardiovascular surgeries in a state hospital setting, (2) cost-effectiveness of PBM with a model based on transfusion of red blood cells (RBCs) in cardiovascular surgeries, and (3) the budget impact of PBM implementation based on transfusion of RBCs. METHODS Cost-effectiveness and budget impact models, based on the numbers of avoided transfusions and avoided complications after implementation of the PBM program, were compared between pre- and post-PBM periods at the cardiovascular surgery department of Ankara Bilkent City Hospital between February 11, 2019 and July 24, 2022. The probabilities of transfusions and complications with and without PBM were taken from recent meta-analyses. Data from the Ankara Bilkent City Hospital transfusion center informed the pre- and post-PBM calculations. Costs were calculated from the Social Security Institution's perspective. RESULTS There was a 21% decrease in the use of RBCs and a 23.7% decrease in use of all blood products after the implementation of PBM. The number of RBC packs per patient reduced by 0.88 packs (21%). The cost saving from reduction of RBC transfusions per patient was 518.68 Turkish lira (TRY) and for the hospital it was 1,635,948 TRY. Fewer complications and lower costs in favor of the post-PBM arm were demonstrated in the cost-effectiveness analysis. On the basis of the budget impact model, in 20 months, the hospital's cardiovascular surgery department saved 6,596,934 TRY (€342,302). CONCLUSION This hospital-based study demonstrated that PBM is a budget-saving and cost-effective option in Turkey.
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Affiliation(s)
- Laser Şanal
- Transfusion Center, Ministry of Health, Ankara Bilkent City Hospital Campus, Ankara, Turkey.
| | - Serdar Günaydın
- Department of Cardiovascular Surgery, University of Health Sciences, Ankara Bilkent City Hospital Campus, Ankara, Turkey
| | - Mehtap Tatar
- Vitale Health Economics, Policy and Consultancy, London, UK
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Sharma A, Sharma DK, Datta S. Blood Utilization Trends in Obstetrics and Gynecology: A Seven-Year Retrospective Study in a Teaching Hospital in Sikkim, India. Cureus 2023; 15:e45293. [PMID: 37846231 PMCID: PMC10576974 DOI: 10.7759/cureus.45293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/18/2023] Open
Abstract
INTRODUCTION Unutilized cross-matched blood due to excess cross-match requisitions results in unnecessary wastage of inventory, time, labor, and financial resources. This retrospective cross-sectional study aims to assess the blood utilization practices in obstetrics/gynecology (OB/GYN) over a period of seven years with respect to "blood utilization indices" and standard recommendations. MATERIAL AND METHODS Cross-match requisitions from the OB/GYN Department over a period of seven years (2012-2018) were selected and included in the study using a suitable sampling technique. Patient details were retrieved from the Hospital Information System (HIS) database. The preoperative crossmatch requisitions and blood utilization data were recorded. "Blood utilization indices" and whole blood/component utilization patterns were analyzed. RESULTS A total of 894 units of blood were cross-matched for 523 patients included in the study. A total of 305 of these patients were transfused with 445 units. During the initial phase of the study (2012-2014), the average cross-match-to-transfusion ratio (CTR, 6.6), transfusion probability (12.3), transfusion index (0.23), and component utilization (4%) were in marked deviation from recommended "blood utilization indices." This was in contrast with the later phase of the study (2015-2018) wherein the average CTR (1.5), transfusion probability (69.3), transfusion index (1.3), and component utilization (91.8%) were compliant with recommended "blood utilization indices." CONCLUSION A progressive improvement in blood utilization practices was observed in the OB/GYN Department during the study period. Awareness campaigns have contributed to the implementation of rational and judicious blood transfusion practices in our center.
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Affiliation(s)
- Akanksha Sharma
- Cardiology, Yatharth Super Specialty Hospitals, Greater Noida, IND
| | - Dhruva K Sharma
- Pharmacology and Therapeutics, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Gangtok, IND
| | - Supratim Datta
- Pharmacology and Therapeutics, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Gangtok, IND
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3
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Catarci M, Guadagni S, Masedu F, Montemurro LA, Ciano P, Benedetti M, Delrio P, Garulli G, Pirozzi F, Scatizzi M. Blood Transfusions and Adverse Events after Colorectal Surgery: A Propensity-Score-Matched Analysis of a Hen-Egg Issue. Diagnostics (Basel) 2023; 13:diagnostics13050952. [PMID: 36900095 PMCID: PMC10000587 DOI: 10.3390/diagnostics13050952] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Blood transfusions are considered a risk factor for adverse outcomes after colorectal surgery. However, it is still unclear if they are the cause (the hen) or the consequence (the egg) of adverse events. A prospective database of 4529 colorectal resections gathered over a 12-month period in 76 Italian surgical units (the iCral3 study), reporting patient-, disease-, and procedure-related variables, together with 60-day adverse events, was retrospectively analyzed identifying a subgroup of 304 cases (6.7%) that received intra- and/or postoperative blood transfusions (IPBTs). The endpoints considered were overall and major morbidity (OM and MM, respectively), anastomotic leakage (AL), and mortality (M) rates. After the exclusion of 336 patients who underwent neo-adjuvant treatments, 4193 (92.6%) cases were analyzed through a 1:1 propensity score matching model including 22 covariates. Two well-balanced groups of 275 patients each were obtained: group A, presence of IPBT, and group B, absence of IPBT. Group A vs. group B showed a significantly higher risk of overall morbidity (154 (56%) vs. 84 (31%) events; OR 3.07; 95%CI 2.13-4.43; p = 0.001), major morbidity (59 (21%) vs. 13 (4.7%) events; OR 6.06; 95%CI 3.17-11.6; p = 0.001), and anastomotic leakage (31 (11.3%) vs. 8 (2.9%) events; OR 4.72; 95%CI 2.09-10.66; p = 0.0002). No significant difference was recorded between the two groups concerning the risk of mortality. The original subpopulation of 304 patients that received IPBT was further analyzed considering three variables: appropriateness of BT according to liberal transfusion thresholds, BT following any hemorrhagic and/or major adverse event, and major adverse event following BT without any previous hemorrhagic adverse event. Inappropriate BT was administered in more than a quarter of cases, without any significant influence on any endpoint. The majority of BT was administered after a hemorrhagic or a major adverse event, with significantly higher rates of MM and AL. Finally, a major adverse event followed BT in a minority (4.3%) of cases, with significantly higher MM, AL, and M rates. In conclusion, although the majority of IPBT was administered with the consequence of hemorrhage and/or major adverse events (the egg), after adjustment accounting for 22 covariates, IPBT still resulted in a definite source of a higher risk of major morbidity and anastomotic leakage rates after colorectal surgery (the hen), calling urgent attention to the implementation of patient blood management programs.
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Affiliation(s)
- Marco Catarci
- General Surgery Unit, Sandro Pertini Hospital, ASL Roma 2, 00157 Rome, Italy
- Correspondence:
| | - Stefano Guadagni
- General Surgery Unit, University of L’Aquila, 67100 L’Aquila, Italy
| | - Francesco Masedu
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy
| | | | - Paolo Ciano
- General Surgery Unit, Sandro Pertini Hospital, ASL Roma 2, 00157 Rome, Italy
| | - Michele Benedetti
- General Surgery Unit, Sandro Pertini Hospital, ASL Roma 2, 00157 Rome, Italy
| | - Paolo Delrio
- Colorectal Surgical Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori, “Fondazione Giovanni Pascale IRCCS-Italia”, 80131 Napoli, Italy
| | | | - Felice Pirozzi
- General Surgery Unit, ASL Napoli 2 Nord, 80078 Pozzuoli (NA), Italy
| | - Marco Scatizzi
- General Surgery Unit, Santa Maria Annunziata & Serristori Hospital, 50012 Firenze, Italy
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Hindawi S. Patient Blood Management: Why We Need to Change. Transfusion 2023; 63 Suppl 1:S1-S2. [PMID: 36468675 DOI: 10.1111/trf.17211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Salwa Hindawi
- Saudi Society of Transfusion Medicine & Services, Saudi Arabia
- Haematology Department, Faculity of Medicine at King Abdulaziz University, Jeddah, Saudi Arabia
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Hofmann A, Aapro M, Fedorova TA, Zhiburt YB, Snegovoy AV, Kaganov OI, Ognerubov NA, Lyadov VK, Moiseenko VM, Trofimova OP, Ashrafyan LA, Khasanov RS, Poddubnaya IV. Patient blood management in oncology in the Russian Federation: Resolution to improve oncology care. J Cancer Policy 2022; 31:100315. [DOI: 10.1016/j.jcpo.2021.100315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/31/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022]
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Shander A, Hardy JF, Ozawa S, Farmer SL, Hofmann A, Frank SM, Kor DJ, Faraoni D, Freedman J. A Global Definition of Patient Blood Management. Anesth Analg 2022; 135:476-488. [PMID: 35147598 DOI: 10.1213/ane.0000000000005873] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
While patient blood management (PBM) initiatives are increasingly adopted across the globe as part of standard of care, there is need for a clear and widely accepted definition of PBM. To address this, an expert group representing PBM organizations, from the International Foundation for Patient Blood Management (IFPBM), the Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis (NATA), the Society for the Advancement of Patient Blood Management (SABM), the Western Australia Patient Blood Management (WAPBM) Group, and OnTrac (Ontario Nurse Transfusion Coordinators) convened and developed this definition: "Patient blood management is a patient-centered, systematic, evidence-based approach to improve patient outcomes by managing and preserving a patient's own blood, while promoting patient safety and empowerment." The definition emphasizes the critical role of informed choice. PBM involves the timely, multidisciplinary application of evidence-based medical and surgical concepts aimed at screening for, diagnosing and appropriately treating anemia, minimizing surgical, procedural, and iatrogenic blood losses, managing coagulopathic bleeding throughout the care and supporting the patient while appropriate treatment is initiated. We believe that having a common definition for PBM will assist all those involved including PBM organizations, hospital administrators, individual clinicians and policy makers to focus on the appropriate issues when discussing and implementing PBM. The proposed definition is expected to continue to evolve, making this endeavor a work in progress.
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Affiliation(s)
- Aryeh Shander
- From the Department of Anesthesiology, Critical Care and Hyperbaric Medicine, Englewood Health, Englewood, New Jersey.,Society for the Advancement of Patient Blood Management (SABM), Mount Royal, New Jersey
| | - Jean-Francois Hardy
- Department of Anaesthesiology and Pain Medicine, Université de Montréal, Montréal, Quebec, Canada.,Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis (NATA), Paris, France
| | - Sherri Ozawa
- Society for the Advancement of Patient Blood Management (SABM), Mount Royal, New Jersey.,Institute for Patient Blood Management and Bloodless Medicine and Surgery, Englewood Health, Englewood, New Jersey
| | - Shannon L Farmer
- Medical School and Division of Surgery, Faculty of Medicine and Health Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Department of Haematology, Royal Perth Hospital, Perth, Western Australia, Australia.,International Foundation for Patient Blood Management, Basel, Switzerland.,The Western Australia Patient Blood Management Group, The University of Western Australia, Perth, Western Australia, Australia
| | - Axel Hofmann
- Medical School and Division of Surgery, Faculty of Medicine and Health Sciences, The University of Western Australia, Perth, Western Australia, Australia.,International Foundation for Patient Blood Management, Basel, Switzerland.,Department of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Steven M Frank
- Department of Anesthesiology, Critical Care Medicine, Johns Hopkins Health System Patient Blood Management Program, The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland
| | - Daryl J Kor
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Michigan.,Patient Blood Management Program, Mayo Clinic, Rochester, Michigan
| | - David Faraoni
- Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis (NATA), Paris, France.,Department of Anesthesiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - John Freedman
- Ontario Nurse Transfusion Coordinators Program (ONTraC), Ontario, Canada.,The Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Golukhova EZ, Kupryashov AA, Khicheva GA, Kuksina EV, Volkova OI, Kurilovich EO, Popovich LD. Socio-economic assessment of patient blood management practical implementation in surgical treatment of coronary heart disease (I20-I25). ACTA ACUST UNITED AC 2021; 61:77-86. [PMID: 33849423 DOI: 10.18087/cardio.2021.3.n1557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/16/2021] [Indexed: 11/18/2022]
Abstract
Aim To evaluate possible social and economic benefits of correcting preoperative iron deficiency /iron deficiency anemia as a comorbidity in a model population in the process of transition from the routine practice to the optimized preparation of patients to elective surgery (as exemplified by several circulatory diseases: I20 - I25, class IX ICD 10).Material and methods By building imitation models depending on the patient blood management (PBM) practice, changes in years of life lost/saved adjusted for disability were evaluated, including in monetary terms, in relation to the annual number of operations performed for ischemic heart disease (IHD) (I20 - I25) in the age group of 17 years and older, as well as a potential effect of PBM on the applied health economics.Results With implementation of the PBM systemic measures in cardiac surgery, the potentially prevented annual social and economic damage will amount to more than 38 thousand years of life saved and more than 20.2 billion rubles in monetary terms. Furthermore, it will be possible to exclude 9435 hemotransfusion from the cardiosurgical practice, which will annually save more than 2.3 thousand liters of blood with a total cost of 77.7 million rubles in favor of clinical situations that have no alternative.Conclusion The implementation of PBM in cardiac surgery, the discipline with the highest levels of preoperative iron deficiency/anemia and the use of blood components, will not only improve the clinical outcomes and cost-effectiveness of surgical interventions, but will also prevent social and economic damage to the country.
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Affiliation(s)
- E Z Golukhova
- Bakulev National Medical Research Center of Cardiovascular Surgery, Moscow, Russia
| | - A A Kupryashov
- Bakulev National Medical Research Center of Cardiovascular Surgery, Moscow, Russia
| | - G A Khicheva
- Bakulev National Medical Research Center of Cardiovascular Surgery, Moscow, Russia
| | - E V Kuksina
- Bakulev National Medical Research Center of Cardiovascular Surgery, Moscow, Russia
| | - O I Volkova
- Institute of Health Economics, National Research University Higher School of Economics, Moscow, Russia
| | - E O Kurilovich
- Institute of Health Economics, National Research University Higher School of Economics, Moscow, Russia
| | - L D Popovich
- Institute of Health Economics, National Research University Higher School of Economics, Moscow, Russia
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Chung YH, Lee KA, Cho M, Shin S, Lee BK. Performance comparison of platelet function analyzers in cardiology patients: VerifyNow and Anysis-200 aspirin assays. Clin Hemorheol Microcirc 2020; 76:33-42. [DOI: 10.3233/ch-200822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND: Analysis of responsiveness to antiplatelet therapy is crucial in the management of patients with cardiovascular diseases. OBJECTIVE: This study aimed to evaluate a new platelet function analysis system (Anysis-200) and to compare it with VerifyNow (Accumetrics, San Diego, CA, USA) in cardiology patients. METHODS: Overall, 125 citrated blood samples were collected from 85 cardiology patients referred for platelet function testing. In Anysis-200, platelet function was measured as blood migration distance (MD) until clogging of flow passage, which is comparable to aspirin resistance units obtained using VerifyNow. The two devices were simultaneously used and compared. RESULTS: The MDs before and after taking aspirin were 175±51 and 247±27 mm, respectively (p < 0.0001). Compared with VerifyNow (reference), the sensitivity and specificity of Anysis-200 was 91.5% and 75.5%, respectively (area under the curve, 0.829). Further, the true positive rate in patients newly taking aspirin was 85% for VerifyNow and 92.5% for Anysis-200, respectively. The Cohen’s kappa coefficient between the two devices was 0.682, indicating a relatively high agreement. CONCLUSIONS: Anysis-200, a novel system for assessing platelet aggregation, has accuracy and precision equivalent to that of, and significant agreement with, VerifyNow. Anysis-200 may be useful in screening patients with abnormal platelet reactivity and aspirin nonresponsiveness.
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Affiliation(s)
- Young Hak Chung
- Department of Internal Medicine, Division of Cardiology, College of Medicine, Yonsei University, Seoul, Korea
| | - Kyung Ah Lee
- Department of Laboratory Medicine, College of Medicine, Yonsei University, Seoul, Korea
| | - Minhee Cho
- Department of Internal Medicine, Division of Cardiology, College of Medicine, Yonsei University, Seoul, Korea
| | - Sehyun Shin
- Department of Mechanical Engineering, Korea University, Seoul, Korea
| | - Byoung Kwon Lee
- Department of Internal Medicine, Division of Cardiology, College of Medicine, Yonsei University, Seoul, Korea
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Marshall A, Davidson A. Patient blood management in NHSBT. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:1079-1081. [PMID: 33035101 DOI: 10.12968/bjon.2020.29.18.1079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Andrea Marshall
- Patient Blood Management Development Manager, NHS Blood and Transplant
| | - Anne Davidson
- Patient Blood Management Education Lead, NHS Blood and Transplant
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Drabinski T, Zacharowski K, Meybohm P, Rüger AM, Ramirez de Arellano A. Estimating the Epidemiological and Economic Impact of Implementing Preoperative Anaemia Measures in the German Healthcare System: The Health Economic Footprint of Patient Blood Management. Adv Ther 2020; 37:3515-3536. [PMID: 32562124 PMCID: PMC7370967 DOI: 10.1007/s12325-020-01372-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION This study aimed to quantify the potential epidemiological and health economic benefits of implementing preoperative anaemia measures (PAMs) in clinical practice in the German healthcare system. METHODS An evidence-based health economic model was developed to assess the possible impact of implementing PAMs, the first pillar of patient blood management (PBM), in a German population. The analysis of two risk factors-iron-deficiency anaemia (IDA) and receipt of a red blood cell concentrate (RBC) transfusion during elective surgery-allowed the estimation of relative risks (RRs), average cost per patient, average length of hospital stay, and avoided hospital deaths after the implementation of PAMs. RESULTS A total of 4,591,060 patients who had undergone elective surgery during 2015 were identified, of which 29,170 (0.64%) were diagnosed with preoperative IDA. These patients had an increased RR of receiving a RBC transfusion during surgery (RR 5.031; 95% confidence interval [CI] 4.928, 5.136) and increased mortality risk (RR 3.630; 95% CI 3.401, 3.874) versus patients without IDA. Patients who received a RBC transfusion during surgery had a 24.6-times higher risk of death than those who did not (RR 24.593; 95% CI 24.121, 25.075). Average cost of treatment was €7883 in patients with IDA, €21,744 in patients with IDA and RBC transfusion, and €4560 in patients without risk factors. The model identified 29,714 patients (0.65%) who had received a RBC transfusion and who potentially had IDA but remained undiagnosed before surgery. Hypothetical implementation of PAMs would have resulted in an estimated annual net hospital direct cost saving of €1029 million (1.58%) of total hospital direct costs of the German healthcare system and 3036 hospital deaths (0.07%) avoided. CONCLUSIONS This model estimated the impact of implementing PAMs for patients with IDA undergoing elective surgery. A significant number of deaths, costly treatments, and hospital days could have been avoided by the introduction of PAMs in routine clinical practice in Germany.
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Affiliation(s)
- Thomas Drabinski
- Institut für Mikrodaten-Analyse (IfMDA), Harmsstr. 13, 24114, Kiel, Germany.
| | - Kai Zacharowski
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Patrick Meybohm
- Clinic and Polyclinic for Anaesthesiology, Intensive Medicine and Pain Therapy, University Hospital Würzburg, Würzburg, Germany
| | - Alexandra M Rüger
- Vifor Pharma, Baierbrunner Str. 29 (Eingang Baierbrunner Str. 27), 81379, Munich, Germany
- Charité Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Kardiologie Campus Virchow-Klinikum, Berlin, Germany
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11
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Mitterecker A, Hofmann A, Trentino KM, Lloyd A, Leahy MF, Schwarzbauer K, Tschoellitsch T, Böck C, Hochreiter S, Meier J. Machine learning-based prediction of transfusion. Transfusion 2020; 60:1977-1986. [PMID: 32596877 PMCID: PMC7540018 DOI: 10.1111/trf.15935] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/10/2020] [Accepted: 05/15/2020] [Indexed: 12/15/2022]
Abstract
Background The ability to predict transfusions arising during hospital admission might enable economized blood supply management and might furthermore increase patient safety by ensuring a sufficient stock of red blood cells (RBCs) for a specific patient. We therefore investigated the precision of four different machine learning–based prediction algorithms to predict transfusion, massive transfusion, and the number of transfusions in patients admitted to a hospital. Study Design and Methods This was a retrospective, observational study in three adult tertiary care hospitals in Western Australia between January 2008 and June 2017. Primary outcome measures for the classification tasks were the area under the curve for the receiver operating characteristics curve, the F1 score, and the average precision of the four machine learning algorithms used: neural networks (NNs), logistic regression (LR), random forests (RFs), and gradient boosting (GB) trees. Results Using our four predictive models, transfusion of at least 1 unit of RBCs could be predicted rather accurately (sensitivity for NN, LR, RF, and GB: 0.898, 0.894, 0.584, and 0.872, respectively; specificity: 0.958, 0.966, 0.964, 0.965). Using the four methods for prediction of massive transfusion was less successful (sensitivity for NN, LR, RF, and GB: 0.780, 0.721, 0.002, and 0.797, respectively; specificity: 0.994, 0.995, 0.993, 0.995). As a consequence, prediction of the total number of packed RBCs transfused was also rather inaccurate. Conclusion This study demonstrates that the necessity for intrahospital transfusion can be forecasted reliably, however the amount of RBC units transfused during a hospital stay is more difficult to predict.
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Affiliation(s)
| | - Axel Hofmann
- Department of Anesthesiology and Critical Care Medicine, University and University Hospital, Zürich, Switzerland
| | - Kevin M Trentino
- Data and Digital Innovation, East Metropolitan Health Service, Perth, Australia
| | - Adam Lloyd
- Data and Digital Innovation, East Metropolitan Health Service, Perth, Australia
| | - Michael F Leahy
- Department of Haematology, PathWest Laboratory Medicine, Royal Perth Hospital, Perth, Australia
| | - Karin Schwarzbauer
- Institute for Machine Learning, Johannes Kepler University, Linz, Austria
| | - Thomas Tschoellitsch
- Department of Anesthesiology and Critical Care Medicine, Kepler University Hospital GmbH and Johannes Kepler University, Linz, Austria
| | - Carl Böck
- Department of Anesthesiology and Critical Care Medicine, Kepler University Hospital GmbH and Johannes Kepler University, Linz, Austria
| | - Sepp Hochreiter
- Institute for Machine Learning, Johannes Kepler University, Linz, Austria
| | - Jens Meier
- Department of Anesthesiology and Critical Care Medicine, Kepler University Hospital GmbH and Johannes Kepler University, Linz, Austria
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12
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Platelet Activity Measured by VerifyNow® Aspirin Sensitivity Test Identifies Coronary Artery Bypass Surgery Patients at Increased Risk for Postoperative Bleeding and Transfusion. Heart Lung Circ 2020; 29:460-468. [DOI: 10.1016/j.hlc.2019.03.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 03/01/2019] [Accepted: 03/19/2019] [Indexed: 11/19/2022]
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13
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Increased risk of blood transfusion in patients with diabetes mellitus sustaining non-major burn injury. Burns 2019; 46:888-896. [PMID: 31848083 DOI: 10.1016/j.burns.2019.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 09/01/2019] [Accepted: 10/20/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Due to the increased mortality and morbidity associated with blood transfusion, identifying modifiable predictors of transfusion are vital to prevent or minimise blood use. We hypothesised that burn patients with diabetes mellitus were more likely to be prescribed a transfusion. These patients tend to have increased age, number of comorbidities, infection risk and need for surgery which are all factors reported previously to be associated with blood use. OBJECTIVE To determine whether patients with diabetes mellitus who have sustained a burn ≤20% total body surface area (TBSA) are at higher risk of receiving red blood cell transfusion compared to those without diabetes mellitus. METHOD This was a retrospective cohort study including patients admitted to the major Burns Unit in Western Australia for management of a burn injury. Only the first hospital admission between May 2008 to February 2017 were included. RESULTS Among 2101 patients with burn injuries ≤20% TBSA, 48 (2.3%) received packed red blood cells and 169 (8.0%) had diabetes. There were 13 (7.7%) diabetic patients that were transfused versus 35 (1.8%) non-diabetic patients. Patients with diabetes were 5.2 (p = 0.034) times more likely to receive packed red blood cells after adjusting for percentage TBSA, haemoglobin at admission or prior to transfusion, number of surgeries, total comorbid burden and incidence of infection. As percentage TBSA increases, the probability of packed red blood cell transfusion increases at a higher rate in DM patients. CONCLUSIONS This study showed that diabetic patients with burn injuries ≤20% TBSA have a higher probability of receiving packed red blood cell transfusion compared to patients without diabetes. This effect was compounded in burns with higher percentage TBSA.
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Kwak J, Wilkey AL, Abdalla M, Joshi R, Roman PEF, Greilich PE. Perioperative Blood Conservation: Guidelines to Practice. Adv Anesth 2019; 37:1-34. [PMID: 31677651 DOI: 10.1016/j.aan.2019.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Jenny Kwak
- Department of Anesthesiology and Perioperative Medicine, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
| | - Andrew L Wilkey
- Department of Anesthesia, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN 55407, USA
| | - Mohamed Abdalla
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic Lerner College of Medicine, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue/J4-331, Cleveland, OH 44196, USA
| | - Ravi Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center - Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390-8894, USA
| | - Philip E F Roman
- Department of Anesthesiology, Centura St. Anthony Hospital, United States Anesthesia Partners, 11600 West 2nd Place, Lakewood, CO 80228, USA
| | - Philip E Greilich
- Cardiac Anesthesiology, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center - Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390-8894, USA
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15
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Terwindt L, Karlas A, Eberl S, Wijnberge M, Driessen A, Veelo D, Geerts B, Hollmann M, Vlaar A. Patient blood management in the cardiac surgical setting: An updated overview. Transfus Apher Sci 2019; 58:397-407. [DOI: 10.1016/j.transci.2019.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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16
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The efficacy of pre-operative preparation with intravenous iron and/or erythropoietin in anaemic patients undergoing orthopaedic surgery: An observational study. Eur J Anaesthesiol 2019; 35:289-297. [PMID: 29303906 DOI: 10.1097/eja.0000000000000752] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Pre-operative anaemia and transfusion are common among patients undergoing elective orthopaedic surgery. Application of 'patient blood management' might be the most effective way to reduce both anaemia and transfusion. Pre-operative administration of iron and/or erythropoietin (EPO) is one of the cornerstones of the first pillar of patient blood management, but in a daily clinical setting, efficacy and long-term safety of this measure have not been analysed thoroughly to date. OBJECTIVE To investigate the influence of pre-operative preparation (PREP) of patients with iron and/or EPO on peri-operative transfusion needs and long-term survival. DESIGN Single-centre, retrospective study. SETTING Anaesthesia department, University hospital. INTERVENTIONS Pre-operative preparation with iron and/or EPO versus no preparation. METHODS After approval of our local ethics committee, data of 5518 patients who received total hip or total knee replacement between 2008 and 2014 were included. Patients receiving iron and/or EPO were included in the PREP group, whereas patients without iron and/or EPO were included in the no preparation group. From the full data set, a bias-reduced subset of 662 patients was obtained by means of propensity score-matching to compare peri-operative red blood cell utilisation and long-term survival of patients between groups. RESULTS Patients in the PREP group needed a lower number of units of red blood cells than patients in the no preparation group (0.2 ± 0.8 vs. 0.5 ± 1.3, P < 0.001), had a lower transfusion rate (12 vs. 24%, P < 0.05) and had a similar haemoglobin concentration (10.7 ± 1.3 vs. 10.6 ± 1.1 g dl, not significant) at discharge. No differences in long-term survival were observed between the two study groups. CONCLUSION PREP of patients with iron and/or EPO in orthopaedic patients can be considered highly effective in terms of transfusion reduction, without influencing long-term survival.
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17
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Sakai T, Biancofiore G. Patient blood management: a call to anesthesiologists for leadership. Minerva Anestesiol 2019; 85:577-579. [PMID: 30947486 DOI: 10.23736/s0375-9393.19.13700-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Tetsuro Sakai
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA -
| | - Gianni Biancofiore
- Transplant Anesthesia and Critical Care, University Hospital of Pisa, Pisa, Italy
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18
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Pollock RF, Muduma G. A systematic literature review and indirect comparison of iron isomaltoside and ferric carboxymaltose in iron deficiency anemia after failure or intolerance of oral iron treatment. Expert Rev Hematol 2019; 12:129-136. [PMID: 30689458 DOI: 10.1080/17474086.2019.1575202] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The efficacy of oral iron in treating iron deficiency anemia (IDA) can be limited by poor gastrointestinal (GI) absorption and adverse GI symptoms; intravenous (IV) iron is a well-established alternative. The present study compared the efficacy of two IV iron formulations in patients with IDA: iron isomaltoside (IIM) and ferric carboxymaltose (FCM). METHODS A systematic literature review (SLR) was conducted to identify randomized controlled trials (RCTs) of IIM and FCM in patients with IDA. An adjusted indirect treatment comparison (ITC) of IIM and FCM was then conducted to evaluate differences in change from baseline hemoglobin and the proportion of patients achieving a clinically-relevant response. RESULTS The SLR identified no completed RCTs of IIM versus FCM, 5 RCTs of IIM (4 versus oral iron and 1 versus iron sucrose), and 14 RCTs of FCM (11 versus oral iron and 3 versus iron sucrose). In an ITC via iron sucrose, IIM resulted in a significantly larger increase from baseline hemoglobin with a mean difference of +0.249 g/dL with IIM relative to FCM, but there was no significant difference in the proportion of patients with a clinically-relevant response. CONCLUSIONS IIM resulted in a larger increase from baseline hemoglobin than FCM in patients with IDA, but with no difference in the proportion of patients responding. Studies comparing IIM and FCM directly would be needed to confirm these findings.
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Affiliation(s)
| | - Gorden Muduma
- b International Market Access , Pharmacosmos A/S , Holbæk , Denmark
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19
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Voorn VMA, van Bodegom-Vos L, So-Osman C. Towards a systematic approach for (de)implementation of patient blood management strategies. Transfus Med 2018; 28:158-167. [PMID: 29508467 DOI: 10.1111/tme.12520] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/26/2018] [Accepted: 02/12/2018] [Indexed: 12/14/2022]
Abstract
Despite the increasing availability of evidence in transfusion medicine literature, this evidence does not automatically find its way into practice. This is also applicable to patient blood management (PBM). It may concern the lack of implementation of effective new techniques or treatments, or it may apply to the (over)use of techniques and treatments (e.g. inappropriate transfusions) that have proven to be of limited benefit for patients (low-value care) and could be abandoned (de-implementation). In PBM literature, the implementation of restrictive transfusion thresholds and the de-implementation of inappropriate transfusions are described. However, most implementation strategies were not preceded by the identification of relevant barriers, and the used strategies were not often supported by literature on behavioural changes. In this article, we describe implementation vs de-implementation, highlight the current situation of (de)implementation in PBM and describe a systematic approach for (de)implementation illustrated by an example of a PBM de-implementation study regarding '(cost-) effective patient blood management in total hip and knee arthroplasty'. The systematic approach used for (de)implementation is based on the implementation model of Grol, which consists of the following five steps: the detection of improvement goals, a problem analysis, the selection of (de)implementation strategies, the execution of the (de)implementation strategy and an evaluation. Based on the description of the current situation and the experiences in our de-implementation study, we can conclude that de-implementation may be more difficult than expected as other factors may play a role in effective de-implementation compared to implementation.
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Affiliation(s)
- V M A Voorn
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.,Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - L van Bodegom-Vos
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - C So-Osman
- Unit Transfusion Medicine, Sanquin, Leiden, The Netherlands.,Department of Internal Medicine, Groene Hart Hospital, Gouda, The Netherlands
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20
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Bruun MT, Georgsen J, Titlestad K, Yazer M, Murphy MF. Patient Blood Management - from local initiatives to European collaborations. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/voxs.12369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- M. T. Bruun
- Department of Clinical Immunology; Odense University Hospital; Odense C Denmark
- Member of PaBloE; Working Group of the European Blood Alliance
| | - J. Georgsen
- Department of Clinical Immunology; Odense University Hospital; Odense C Denmark
- Member of PaBloE; Working Group of the European Blood Alliance
| | - K. Titlestad
- Department of Clinical Immunology; Odense University Hospital; Odense C Denmark
| | - M. Yazer
- Department of Clinical Immunology; Odense University Hospital; Odense C Denmark
- University of Pittsburgh; Pittsburgh PA USA
| | - M. F. Murphy
- Member of PaBloE; Working Group of the European Blood Alliance
- NHS Blood & Transplant; Oxford UK
- Oxford University Hospitals NHS Foundation Trust; Oxford UK
- University of Oxford; Oxford UK
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21
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Butcher A, Richards T. Cornerstones of patient blood management in surgery. Transfus Med 2017; 28:150-157. [PMID: 28940786 DOI: 10.1111/tme.12476] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/11/2017] [Accepted: 08/28/2017] [Indexed: 12/22/2022]
Abstract
Pre-operative anaemia and perioperative red blood cell transfusion carry significant consequence when it comes to surgical outcomes. The establishment of patient-centred clinical pathways has been designed to harness and endorse good transfusion practice, termed the three pillars of patient blood management (PBM). These focus on the timely and appropriate management of anaemia, prevention of blood loss and restrictive transfusion where appropriate. This article reviews the current evidence and ongoing research in the field of PBM in surgery. Strategies to implement PBM have shown significant benefits in appropriate transfusion practice, reduced costs and improved length of hospital stay. Recently published national quality standards have recognised the features of the PBM blueprint such as the consideration of alternatives to red blood cell transfusion, the active measures to reduce perioperative blood loss and the appropriate management of post-operative anaemia. Adopting PBM in surgical patients should be paramount to reduce the risks posed by perioperative anaemia and blood transfusions. The principles of PBM help structure the interventions and decisions relating to anaemia and blood transfusion, but, more importantly, represent a paradigm shift towards a more considered approach to blood transfusion, acknowledging its risks, preventatives and alternatives.
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Affiliation(s)
- A Butcher
- Division of Surgery and Interventional Science, University College London, London, UK
| | - T Richards
- Division of Surgery and Interventional Science, University College London, London, UK
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22
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Leahy MF, Trentino KM, May C, Swain SG, Chuah H, Farmer SL. Blood use in patients receiving intensive chemotherapy for acute leukemia or hematopoietic stem cell transplantation: the impact of a health system-wide patient blood management program. Transfusion 2017; 57:2189-2196. [PMID: 28671296 DOI: 10.1111/trf.14191] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 04/23/2017] [Accepted: 04/24/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Little is published on patient blood management (PBM) programs in hematology. In 2008 Western Australia announced a health system-wide PBM program with PBM staff appointments commencing in November 2009. Our aim was to assess the impact this program had on blood utilization and patient outcomes in intensive chemotherapy for acute leukemia or hematopoietic stem cell transplantation. STUDY DESIGN AND METHODS A retrospective study of 695 admissions at two tertiary hospitals receiving intensive chemotherapy for acute leukemia or undergoing hematopoietic stem cell transplantation between July 2010 and December 2014 was conducted. Main outcomes included pre-red blood cell (RBC) transfusion hemoglobin (Hb) levels, single-unit RBC transfusions, number of RBC and platelet (PLT) units transfused per admission, subsequent day case transfusions, length of stay, serious bleeding, and in-hospital mortality. RESULTS Over the study period, the mean RBC units transfused per admission decreased 39% from 6.1 to 3.7 (p < 0.001), and the mean PLT units transfused decreased 35% from 6.3 to 4.1 (p < 0.001), with mean RBC and PLT units transfused for follow-up day cases decreasing from 0.6 to 0.4 units (p < 0.001). Mean pre-RBC transfusion Hb level decreased from 8.0 to 6.8 g/dL (p < 0.001), and single-unit RBC transfusions increased 39% to 67% (p < 0.001). This reduction represents blood product cost savings of AU$694,886 (US$654,007). There were no significant changes in unadjusted or adjusted length of stay, serious bleeding events, or in-hospital mortality over the study. CONCLUSION The health system-wide PBM program had a significant impact, reducing blood product use and costs without increased morbidity or mortality in patients receiving intensive chemotherapy for acute leukemia or hematopoietic stem cell transplantation.
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Affiliation(s)
- Michael F Leahy
- School of Medicine and Pharmacology
- Department of Haematology
- PathWest Laboratory Medicine, Royal Perth Hospital
| | | | | | - Stuart G Swain
- Business Intelligence Unit, South Metropolitan Health Service
| | | | - Shannon L Farmer
- School of Surgery, Faculty of Medicine Dentistry and Health Sciences, The University of Western Australia
- Centre for Population Health Research, Faculty of Health, Sciences, Curtin University, Perth, Western Australia, Australia
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23
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Badenes R, Oddo M, Suarez JI, Antonelli M, Lipman J, Citerio G, Taccone FS. Hemoglobin concentrations and RBC transfusion thresholds in patients with acute brain injury: an international survey. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017. [PMID: 28623949 PMCID: PMC5473997 DOI: 10.1186/s13054-017-1748-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background The optimal hemoglobin (Hb) threshold at which to initiate red blood cell (RBC) transfusion in patients with acute brain injury is unknown. The aim of this survey was to investigate RBC transfusion practices used with these patients. Methods We conducted a web-based survey within various societies of critical care medicine for intensive care unit (ICU) physicians who currently manage patients with primary acute brain injury. Results A total of 868 responses were obtained from around the world, half of which (n = 485) were from European centers; 204 (24%) respondents had a specific certificate in neurocritical care, and most were specialists in anesthesiology or intensive care and had less than 15 years of practice experience. Four hundred sixty-six respondents (54%) said they used an Hb threshold of 7–8 g/dl to initiate RBC transfusion after acute brain injury, although half of these respondents used a different threshold (closer to 9 g/dl) in patients with traumatic brain injury, subarachnoid hemorrhage, or ischemic stroke. Systemic and cerebral factors were reported as influencing the need for higher Hb thresholds. Most respondents agreed that a randomized clinical trial was needed to compare two different Hb thresholds for RBC transfusion, particularly in patients with traumatic brain injury, subarachnoid hemorrhage, and ischemic stroke. Conclusions The Hb threshold used for RBC transfusion after acute brain injury was less than 8 g/dl in half of the ICU clinicians who responded to our survey. However, more than 50% of these physicians used higher Hb thresholds in certain conditions. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1748-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rafael Badenes
- Department of Anesthesiology and Surgical Intensive Care, Hospital Clinic Universitari, Valencia, Spain
| | - Mauro Oddo
- Department of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Hospital, 1011, Lausanne, Switzerland
| | - José I Suarez
- Division of Vascular Neurology and Neurocritical Care, Department of Neurology, Baylor College of Medicine, Catholic Health Initiatives (CHI) Baylor St. Luke's-Baylor St. Luke's Medical Center, Houston, TX, USA
| | - Massimo Antonelli
- Department of Anesthesiology and Intensive Care Medicine, Catholic University - Fondazione Policlinico Agostino Gemelli University Hospital, Rome, Italy
| | - Jeffrey Lipman
- Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, Australia.,Burns Trauma Critical Care Research Centre, University of Queensland, Herston, Australia
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Neurointensive Care, San Gerardo Hospital, Azienda Socio Sanitaria Territoriale (ASST) of Monza, Monza, Italy
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Free University of Brussels (ULB), Route de Lennik, 808-1070, Brussels, Belgium.
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24
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Patient Blood Management is Associated With a Substantial Reduction of Red Blood Cell Utilization and Safe for Patient's Outcome. Ann Surg 2016; 264:203-11. [DOI: 10.1097/sla.0000000000001747] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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25
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Patient Blood Management Bundles to Facilitate Implementation. Transfus Med Rev 2016; 31:62-71. [PMID: 27317382 DOI: 10.1016/j.tmrv.2016.05.012] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/25/2016] [Accepted: 05/25/2016] [Indexed: 12/22/2022]
Abstract
More than 30% of the world's population are anemic with serious economic consequences including reduced work capacity and other obstacles to national welfare and development. Red blood cell transfusion is the mainstay to correct anemia, but it is also 1 of the top 5 overused procedures. Patient blood management (PBM) is a proactive, patient-centered, and multidisciplinary approach to manage anemia, optimize hemostasis, minimize iatrogenic blood loss, and harness tolerance to anemia. Although the World Health Organization has endorsed PBM in 2010, many hospitals still seek guidance with the implementation of PBM in clinical routine. Given the use of proven change management principles, we propose simple, cost-effective measures enabling any hospital to reduce both anemia and red blood cell transfusions in surgical and medical patients. This article provides comprehensive bundles of PBM components encompassing 107 different PBM measures, divided into 6 bundle blocks acting as a working template to develop institutions' individual PBM practices for hospitals beginning a program or trying to improve an already existing program. A stepwise selection of the most feasible measures will facilitate the implementation of PBM. In this manner, PBM represents a new quality and safety standard.
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26
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Shander A, Isbister J, Gombotz H. Patient blood management: the global view. Transfusion 2016; 56 Suppl 1:S94-102. [DOI: 10.1111/trf.13529] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Aryeh Shander
- Department of Anesthesiology, Critical Care and Hyperbaric Medicine; Englewood Hospital and Medical Center; Englewood New Jersey
- Department of Anesthesiology, Department of Medicine, Department of Surgery; Mount Sinai School of Medicine; New York New York
| | - James Isbister
- Sydney Medical School, University of Sydney, Northern Clinical School, Royal North Shore Hospital; Sydney NSW Australia
| | - Hans Gombotz
- Department of Anesthesiology and Intensive Care; General Hospital Linz; Linz Austria
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27
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Elhenawy AM, Meyer SR, Bagshaw SM, MacArthur RG, Carroll LJ. Role of preoperative intravenous iron therapy to correct anemia before major surgery: study protocol for systematic review and meta-analysis. Syst Rev 2015; 4:29. [PMID: 25874460 PMCID: PMC4369835 DOI: 10.1186/s13643-015-0016-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 02/24/2015] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Preoperative anemia is a common and potentially serious hematological problem in elective surgery and increases the risk for perioperative red blood cell (RBC) transfusion. Transfusion is associated with postoperative morbidity and mortality. Preoperative intravenous (IV) iron therapy has been proposed as an intervention to reduce perioperative transfusion; however, studies are generally small, limited, and inconclusive. METHODS/DESIGN We propose performing a systematic review and meta-analysis. We will search MEDLINE, EMBASE, EBM Reviews, Cochrane-controlled trial registry, Scopus, registries of health technology assessment and clinical trials, Web of Science, ProQuest Dissertations and Theses, and conference proceedings in transfusion, hematology, and surgery. We will contact our study drug manufacturer for unpublished trials. Titles and abstracts will be identified and assessed by two reviewers for potential relevance. Eligible studies are: randomized or quasi-randomized clinical trials comparing preoperative administration of IV iron with placebo or standard of care to reduce perioperative blood transfusion in anemic patients undergoing major surgery. Screening, data extraction, and quality appraisal will be conducted independently by two authors. Data will be presented in evidence tables and in meta-analytic forest plots. Primary efficacy outcomes are change in hemoglobin concentration and proportion of patients requiring RBC transfusion. Secondary outcomes include number of units of blood or blood products transfused perioperatively, transfusion-related acute lung injury, neurologic complications, adverse events, postoperative infections, cardiopulmonary complications, intensive care unit (ICU) admission/readmission, length of hospital stay, acute kidney injury, and mortality. Dichotomous outcomes will be reported as pooled relative risks and 95% confidence intervals. Continuous outcomes will be reported using calculated weighted mean differences. Meta-regression will be performed to evaluate the impact of potential confounding variables on study effect estimates. DISCUSSION Reducing unnecessary RBC transfusions in perioperative medicine is a clinical priority. This involves the identification of patients at risk of receiving transfusions along with blood conservation strategies. Of potential pharmacological blood conservation strategies, IV iron is a compelling intervention to treat preoperative anemia; however, existing data are uncertain. We propose performing a systematic review and meta-analysis evaluating the efficacy and safety of IV iron administration to anemic patients undergoing major surgery to reduce transfusion and perioperative morbidity and mortality. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015016771.
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Affiliation(s)
- Abdelsalam M Elhenawy
- School of Public Health, University of Alberta, 4075 RTF, 8308 114 Street, Edmonton, Alberta, T6G 2E1, Canada.
| | - Steven R Meyer
- Division of Cardiac Surgery, Department of Cardiac Surgery, Faculty of Medicine and Dentistry, University of Alberta, 8440-112 Street, Edmonton, Alberta, T6G 2B7, Canada.
| | - Sean M Bagshaw
- Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Sciences Building 8440-112 Street, Edmonton, Alberta, T6G 2B7, Canada.
| | - Roderick G MacArthur
- Division of Cardiac Surgery, Department of Cardiac Surgery, Faculty of Medicine and Dentistry, University of Alberta, 8440-112 Street, Edmonton, Alberta, T6G 2B7, Canada.
| | - Linda J Carroll
- School of Public Health, University of Alberta, 4075 RTF, 8308 114 Street, Edmonton, Alberta, T6G 2E1, Canada.
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28
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Orlov YP, Lukach VN, Govorova NV, Baytugaeva GA. [Fear of anemia or why don't we afraid of blood transfusion?]. Khirurgiia (Mosk) 2015:88-94. [PMID: 27010036 DOI: 10.17116/hirurgia20151188-94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Yu P Orlov
- Chair of Anesthesiology and Intensive Care of Omsk State Medical Academy, Russian Ministry of Health, Omsk, Russia
| | - V N Lukach
- Chair of Anesthesiology and Intensive Care of Omsk State Medical Academy, Russian Ministry of Health, Omsk, Russia
| | - N V Govorova
- Chair of Anesthesiology and Intensive Care of Omsk State Medical Academy, Russian Ministry of Health, Omsk, Russia
| | - G A Baytugaeva
- Chair of Anesthesiology and Intensive Care of Omsk State Medical Academy, Russian Ministry of Health, Omsk, Russia
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29
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Meybohm P, Fischer DP, Geisen C, Müller MM, Weber CF, Herrmann E, Steffen B, Seifried E, Zacharowski K. Safety and effectiveness of a Patient Blood Management (PBM) program in surgical patients--the study design for a multi-centre prospective epidemiologic non-inferiority trial. BMC Health Serv Res 2014; 14:576. [PMID: 25927460 PMCID: PMC4261241 DOI: 10.1186/s12913-014-0576-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 11/03/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Preoperative and hospital-acquired anaemia is common among surgical patients. It is associated with an increased risk of morbidity and mortality and a strong risk factor for allogeneic blood transfusions with their own inherent risks. Patient Blood Management (PBM) concepts aim to increase and preserve autologous erythrocyte volume and to optimise haemotherapy. They thus have great potential to benefit patients. METHODS/DESIGN This prospective, multi-centre clinical trial tests the hypothesis that PBM programs are safe and effective in the care of adult surgical patients. Primary outcome is a composite endpoint of adverse events and in-hospital mortality. DISCUSSION This trial will determine whether the implementation of a PBM program is safe and effective in terms of clinical outcome compared to a pre-implementation cohort. This trial is registered at www.clinicaltrials.gov (NCT01820949).
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Affiliation(s)
- Patrick Meybohm
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Dania Patricia Fischer
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Christof Geisen
- German Red Cross Blood Transfusion Service Baden-Wuerttemberg - Hessen, Institute of Transfusion Medicine and Immunohematology, Sandhofstrasse 1, Frankfurt am Main, Germany.
| | - Markus Matthias Müller
- German Red Cross Blood Transfusion Service Baden-Wuerttemberg - Hessen, Institute of Transfusion Medicine and Immunohematology, Sandhofstrasse 1, Frankfurt am Main, Germany.
| | - Christian Friedrich Weber
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Eva Herrmann
- Institute of Biostatistics and Mathematical Modelling, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Björn Steffen
- Department of Haematooncology, University Hospital Frankfurt, Frankfurt am Main, Germany.
| | - Erhard Seifried
- German Red Cross Blood Transfusion Service Baden-Wuerttemberg - Hessen, Institute of Transfusion Medicine and Immunohematology, Sandhofstrasse 1, Frankfurt am Main, Germany.
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
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30
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Graves A, Yates P, Hofmann AO, Farmer S, Ferrari P. Predictors of perioperative blood transfusions in patients with chronic kidney disease undergoing elective knee and hip arthroplasty. Nephrology (Carlton) 2014; 19:404-9. [DOI: 10.1111/nep.12239] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2014] [Indexed: 12/30/2022]
Affiliation(s)
- Angela Graves
- Department of Nephrology; Fremantle Hospital; University of Western Australia; Perth Western Australia Australia
| | - Piers Yates
- Department of Orthopaedics; Fremantle Hospital; University of Western Australia; Perth Western Australia Australia
- School of Surgery; University of Western Australia; Perth Western Australia Australia
| | - Axel O Hofmann
- Western Australian Patient Blood Management Program; Health Department of Western Australia; Perth Western Australia Australia
- Institute of Anaesthesiology; University Hospital Zurich; Zurich Switzerland
| | - Shannon Farmer
- School of Surgery; University of Western Australia; Perth Western Australia Australia
- Western Australian Patient Blood Management Program; Health Department of Western Australia; Perth Western Australia Australia
- Centre for Population Health Research; Curtin University; Perth Western Australia Australia
| | - Paolo Ferrari
- Department of Nephrology; Fremantle Hospital; University of Western Australia; Perth Western Australia Australia
- School of Medicine and Pharmacology; University of Western Australia; Perth Western Australia Australia
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Economic considerations on transfusion medicine and patient blood management. Best Pract Res Clin Anaesthesiol 2014; 27:59-68. [PMID: 23590916 DOI: 10.1016/j.bpa.2013.02.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 02/06/2013] [Indexed: 01/23/2023]
Abstract
In times of escalating health-care cost, it is of great importance to carefully assess the cost-effectiveness and appropriateness of the most resource-consuming health interventions. A long-standing and common clinical practice that has been underestimated in cost and overestimated in effectiveness is the transfusion of allogeneic blood products. Studies show that this intervention comes with largely underestimated service cost and unacceptably high utilisation variability for matched patients, thus adding billions of unnecessary dollars to the health-care expenditure each year. Moreover, a large and increasing body of literature points to a dose-dependent increase of morbidity and mortality and adverse long-term outcomes associated with transfusion whereas published evidence for benefit is extremely limited. This means that transfusion may be a generator for increased hospital stay and possible re-admissions, resulting in additional billions in unnecessary expenditure for the health system. In contrast to this, there are evidence-based and cost-effective treatment options available to pre-empt and reduce allogeneic transfusions. The patient-specific rather than a product-centred application of these multiple modalities is termed patient blood management (PBM). From a health-economic perspective, the expeditious implementation of PBM programmes is clearly indicated. Both patients and payers could benefit from this concept that has recently been endorsed through the World Health Assembly resolution WHA63.12.
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Heier HE. Transfusjonsmedisin ved et hundreårsmerke. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2014; 134:1962-4. [DOI: 10.4045/tidsskr.14.0416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Shander A, Ozawa S, Gross I, Henry D. Erythropoiesis-stimulating agents: friends or foes? Transfusion 2013; 53:1867-72. [PMID: 24015936 DOI: 10.1111/trf.12328] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Litton E, Xiao J, Ho KM. Safety and efficacy of intravenous iron therapy in reducing requirement for allogeneic blood transfusion: systematic review and meta-analysis of randomised clinical trials. BMJ 2013; 347:f4822. [PMID: 23950195 PMCID: PMC3805480 DOI: 10.1136/bmj.f4822] [Citation(s) in RCA: 231] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To evaluate the efficacy and safety of intravenous iron, focusing primarily on its effects on haemoglobin, requirement for transfusion, and risk of infection. DESIGN Systematic review and meta-analysis of randomised controlled trials investigating the safety and efficacy of intravenous iron therapy. DATA SOURCES Randomised controlled trials from Medline, Embase, and the Cochrane Central Register of Controlled Trials from 1966 to June 2013, with no language restrictions. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Eligible trials were randomised controlled trials of intravenous iron compared with either no iron or oral iron. Crossover and observational studies were excluded. MAIN OUTCOME MEASURES Change in haemoglobin concentration and risk of allogeneic red blood cell transfusion (efficacy) and risk of infection (safety). RESULTS Of the 75 trials meeting the inclusion criteria, 72 studies including 10 605 patients provided quantitative outcome data for meta-analysis. Intravenous iron was associated with an increase in haemoglobin concentration (standardised mean difference 6.5 g/L, 95% confidence interval 5.1 g/L to 7.9 g/L) and a reduced risk of requirement for red blood cell transfusion (risk ratio 0.74, 95% confidence interval 0.62 to 0.88), especially when intravenous iron was used with erythroid stimulating agents (ESAs) or in patients with a lower baseline plasma ferritin concentration. There were no significant interactions between the efficacy of intravenous iron and type or dose administered. Intravenous iron was, however, associated with a significant increase in risk of infection (relative risk 1.33, 95% confidence interval 1.10 to 1.64) compared with oral or no iron supplementation. The results remained similar when only high quality trials were analysed. CONCLUSIONS Intravenous iron therapy is effective in increasing haemoglobin concentration and reducing the risk of allogeneic red blood cell transfusion and could have broad applicability to a range of acute care settings. This potential benefit is counterbalanced by a potential increased risk of infection.
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Affiliation(s)
- Edward Litton
- Department of Intensive Care Medicine, Royal Perth Hospital, Perth, Western Australia 6000.
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Leahy MF, Roberts H, Mukhtar SA, Farmer S, Tovey J, Jewlachow V, Dixon T, Lau P, Ward M, Vodanovich M, Trentino K, Kruger PC, Gallagher T, Koay A, Hofmann A, Semmens JB, Towler S. A pragmatic approach to embedding patient blood management in a tertiary hospital. Transfusion 2013; 54:1133-45. [DOI: 10.1111/trf.12362] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 06/21/2013] [Accepted: 06/22/2013] [Indexed: 12/18/2022]
Affiliation(s)
- Michael F. Leahy
- Hematology Department; Fremantle Hospital; Fremantle Western Australia Australia
- University of Western Australia; Perth Western Australia Australia
| | - Heather Roberts
- Department of Health; Curtin University; Perth Western Australia Australia
| | - S. Aqif Mukhtar
- Centre for Population Health Research; Curtin University; Perth Western Australia Australia
| | - Shannon Farmer
- Department of Health; Curtin University; Perth Western Australia Australia
- Centre for Population Health Research; Curtin University; Perth Western Australia Australia
- University of Western Australia; Perth Western Australia Australia
| | - Julie Tovey
- Hematology Department; Fremantle Hospital; Fremantle Western Australia Australia
| | - Val Jewlachow
- Hematology Department; Fremantle Hospital; Fremantle Western Australia Australia
| | - Tracy Dixon
- Hematology Department; Fremantle Hospital; Fremantle Western Australia Australia
| | - Peter Lau
- Hematology Department; Fremantle Hospital; Fremantle Western Australia Australia
| | - Michael Ward
- Anesthetic Department; Fremantle Hospital; Fremantle Western Australia Australia
| | - Matthew Vodanovich
- Hematology Department; Fremantle Hospital; Fremantle Western Australia Australia
| | - Kevin Trentino
- Department of Health; Curtin University; Perth Western Australia Australia
| | - Paul C. Kruger
- Hematology Department; Fremantle Hospital; Fremantle Western Australia Australia
| | - Trudi Gallagher
- Department of Health; Curtin University; Perth Western Australia Australia
| | - Audrey Koay
- Department of Health; Curtin University; Perth Western Australia Australia
| | - Axel Hofmann
- Department of Health; Curtin University; Perth Western Australia Australia
| | - James B. Semmens
- Centre for Population Health Research; Curtin University; Perth Western Australia Australia
| | - Simon Towler
- Department of Health; Curtin University; Perth Western Australia Australia
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Valsami S, Asmis LM. A brief review of 50 years of perioperative thrombosis and hemostasis management. Semin Hematol 2013; 50:79-87. [PMID: 24216167 DOI: 10.1053/j.seminhematol.2013.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Perioperative thrombosis and hemostasis management has changed dramatically over the past 50 years. From two anticoagulants and one anti-aggregant, the number of currently available drugs has recently increased several-fold, leaving clinicians with the problem of choosing the optimal agent. Individualized preoperative assessment of bleeding risk based on bleeding history and testing limited to high-risk patients is an emerging concept. Based on the identification of risk factors for venous thromboembolism (VTE), pharmacologic and non-pharmacologic strategies for perioperative VTE prophylaxis have had a major impact on patient outcome. For patients undergoing surgery who are treated with anticoagulants and anti-aggregants, "bridging" strategies have been proposed. Bleeding management strategies have shifted focus from replacing lost blood volume to new approaches aimed at preventing blood loss, reducing the potential complications of blood loss, and preventing the transfusion of blood products. For some areas of perioperative thrombosis and hemostasis management, randomized controlled trial (RCT) data are emerging, but the database remains insufficient to date. Clearly, more RCTs need to be published for perioperative thrombosis and hemostasis management to become an evidence-based approach.
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Affiliation(s)
- Serena Valsami
- Blood Transfusion Department, Areteion Hospital, Athens University Medical School, Athens, Greece
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The chiasm: Transfusion practice versus patient blood management. Best Pract Res Clin Anaesthesiol 2013; 27:37-42. [DOI: 10.1016/j.bpa.2013.02.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 02/06/2013] [Indexed: 11/18/2022]
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Farmer SL, Towler SC, Leahy MF, Hofmann A. Drivers for change: Western Australia Patient Blood Management Program (WA PBMP), World Health Assembly (WHA) and Advisory Committee on Blood Safety and Availability (ACBSA). Best Pract Res Clin Anaesthesiol 2013; 27:43-58. [DOI: 10.1016/j.bpa.2012.12.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022]
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Post-operative blood salvage in patient blood management: is it really cost-effective and safe? BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 11:175-7. [PMID: 23522880 DOI: 10.2450/2013.0001-13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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