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Anne PB, Kamal M, Singh P, Bodanapu V. Comprehensive approach to patient blood management in India. J Anaesthesiol Clin Pharmacol 2023; 39:682-683. [PMID: 38269156 PMCID: PMC10805189 DOI: 10.4103/joacp.joacp_73_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/26/2022] [Indexed: 01/26/2024] Open
Affiliation(s)
- Puneeth Babu Anne
- Department of Transfusion Medicine and Blood Bank, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Manoj Kamal
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pallavi Singh
- Department of Transfusion Medicine and Blood Bank, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vinay Bodanapu
- Department of Transfusion Medicine and Blood Bank, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Meybohm P, Schmitt E, Choorapoikayil S, Hof L, Old O, Müller MM, Geisen C, Seifried E, Baumhove O, de Leeuw van Weenen S, Bayer A, Friederich P, Bräutigam B, Friedrich J, Gruenewald M, Elke G, Molter GP, Narita D, Raadts A, Haas C, Schwendner K, Steinbicker AU, Jenke DJ, Thoma J, Weber V, Velten M, Wittmann M, Weigt H, Lange B, Herrmann E, Zacharowski K. German Patient Blood Management Network: effectiveness and safety analysis in 1.2 million patients. Br J Anaesth 2023; 131:472-481. [PMID: 37380568 DOI: 10.1016/j.bja.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/04/2023] [Accepted: 05/01/2023] [Indexed: 06/30/2023] Open
Abstract
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. CLINICAL TRIAL REGISTRATION NCT02147795.
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Affiliation(s)
- Patrick Meybohm
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany; University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg, Germany.
| | - Elke Schmitt
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany; Institute of Biostatistics and Mathematical Modelling, Department of Medicine, Goethe University, Frankfurt, Germany
| | - Suma Choorapoikayil
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Lotta Hof
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Oliver Old
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Markus M Müller
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Transfusion Service Baden-Wuerttemberg-Hessen, Kassel, Germany; Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Transfusion Service Baden-Wuerttemberg-Hessen, Frankfurt, Germany
| | - Christof Geisen
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Transfusion Service Baden-Wuerttemberg-Hessen, Frankfurt, Germany
| | - Erhard Seifried
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Transfusion Service Baden-Wuerttemberg-Hessen, Frankfurt, Germany
| | - Olaf Baumhove
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Klinikum Westmuensterland, Bocholt, Germany
| | - Samuel de Leeuw van Weenen
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Klinikum Westmuensterland, Bocholt, Germany
| | - Alexandra Bayer
- Department of Anaesthesiology and Intensive Care Medicine, Agatharied Hospital, Hausham, Germany
| | - Patrick Friederich
- Department of Anaesthesiology, Operative Intensive Care Medicine and Pain Therapy, Muenchen Klinik, Bogenhausen, Munich, Germany
| | - Brigitte Bräutigam
- Central Controlling, Department of Finance, Muenchen Klinik, Bogenhausen, Munich, Germany
| | - Jens Friedrich
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Leverkusen, Leverkusen, Germany
| | - Matthias Gruenewald
- Department of Anaesthesiology and Operative Intensive Care Medicine, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Gunnar Elke
- Department of Anaesthesiology and Operative Intensive Care Medicine, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Gerd P Molter
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Leverkusen, Leverkusen, Germany
| | - Diana Narita
- Institute for Laboratory Diagnostics and Transfusion Medicine, Donauisar Klinikum, Deggendorf/Dingolfing/Landau, Germany
| | - Ansgar Raadts
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Jena, Jena, Germany
| | - Christoph Haas
- Executive Department for Structure, Process and Quality Management, University Hospital Jena, Jena, Germany
| | - Klaus Schwendner
- Department of Anaesthesiology and Operative Intensive Care Medicine, Diakonie Hospital Martha-Maria, Nuremberg, Germany
| | - Andrea U Steinbicker
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany; Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Dana J Jenke
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Josef Thoma
- Department of Anaesthesiology and Operative Intensive Care Medicine, Ortenau Klinikum, Offenburg-Kehl, Germany
| | - Viola Weber
- Department of Anaesthesiology and Operative Intensive Care Medicine, Ortenau Klinikum, Offenburg-Kehl, Germany
| | - Markus Velten
- Department of Anaesthesiology and Operative Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Maria Wittmann
- Department of Anaesthesiology and Operative Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Henry Weigt
- Department of Anaesthesiology, SLK-Kliniken, Heilbronn, Germany
| | - Björn Lange
- Department of Anaesthesiology, SLK-Kliniken, Heilbronn, Germany
| | - Eva Herrmann
- Institute of Biostatistics and Mathematical Modelling, Department of Medicine, Goethe University, Frankfurt, Germany
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
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