Multimodal Patient Blood Management Program Based on a Three-pillar Strategy: A Systematic Review and Meta-analysis.

Abstract

OBJECTIVES:

To determine whether a multidisciplinary, multimodal Patient Blood Management (PBM) program for patients undergoing surgery is effective in reducing perioperative complication rate, and thereby is effective in improving clinical outcome.

BACKGROUND:

PBM is a medical concept with the focus on a comprehensive anemia management, to minimize iatrogenic (unnecessary) blood loss, and to harness and optimize patient-specific physiological tolerance of anemia.

METHODS:

A systematic review and meta-analysis was performed. Eligible studies had to address each of the 3 PBM pillars with at least 1 measure per pillar, for example, preoperative anemia management plus cell salvage plus rational transfusion strategy. The study protocol has been registered with PROSPERO (CRD42017079217).

RESULTS:

Seventeen studies comprising 235,779 surgical patients were included in this meta-analysis (100,886 pre-PBM group and 134,893 PBM group). Implementation of PBM significantly reduced transfusion rates by 39% [risk ratio (RR) 0.61, 95% confidence interval (CI) 0.55-0.68, P < 0.00001], 0.43 red blood cell units per patient (mean difference -0.43, 95% CI -0.54 to -0.31, P < 0.00001), hospital length of stay (mean difference -0.45, 95% CI -0.65 to -0.25, P < 0,00001), total number of complications (RR 0.80, 95% CI 0.74-0.88, P <0.00001), and mortality rate (RR 0.89, 95% CI 0.80-0.98, P = 0.02).

CONCLUSIONS:

Overall, a comprehensive PBM program addressing all 3 PBM pillars is associated with reduced transfusion need of red blood cell units, lower complication and mortality rate, and thereby improving clinical outcome. Thus, this first meta-analysis investigating a multimodal approach should motivate all executives and health care providers to support further PBM activities.

• Authors: Friederike C Althoff, Holger Neb, Eva Herrmann, Kevin M Trentino, Lee Vernich, Christoph Füllenbach, John Freedman, Jonathan H Waters, Shannon Farmer, Michael F Leahy, Kai Zacharowski, Patrick Meybohm, Suma Choorapoikayil
• Journal: Annals of surgery (Ann Surg) Vol. 269 Issue 5 Pg. 794-804 (05 2019) ISSN: 1528-1140 [Electronic] United States
• PMID: 30418206 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Systematic Review)

Topics

• Anemia (complications, therapy)
• Blood Loss, Surgical (prevention & control)
• Blood Transfusion (statistics & numerical data)
• Humans
• Postoperative Complications (etiology, prevention & control)
• Preoperative Care