Effectiveness of Patient Blood Management in Reducing Transfusions in Italian Hospital
Overview
Implementation of a patient blood management (PBM) program at an Italian city hospital significantly reduced red blood cell transfusion rates in abdominal surgery patients, particularly in liver surgery. The program promoted restrictive transfusion triggers and single-unit transfusions without increasing postoperative complications.
Background
Blood transfusions are frequently required in general, cardiac, and orthopedic surgeries, with up to 30% of major abdominal surgery patients needing transfusions. While lifesaving during uncontrolled bleeding, transfusions are associated with increased postoperative morbidity and mortality, especially in oncologic surgeries. Patient blood management (PBM) strategies aim to reduce transfusion use and improve anemia tolerance, but most data on PBM effectiveness come from North America. This study evaluates PBM implementation effects in an Italian hospital setting.
Data Highlights
Parameter
Pre-PBM
Post-PBM
p-value
Number of patients
445
857
Minimally invasive surgery rate
31.5%
38%
0.025
Median preoperative Hb (non-transfused)
13.2 g/dL (12–14.2)
13.1 g/dL (11.9–14.3)
<0.001
Median preoperative Hb (transfused)
10.3 g/dL (9.4–11.9)
10.4 g/dL (9.4–11.6)
<0.001
Transfusion rate in liver surgery
Significantly decreased
Lower rate
Significant
Single-unit transfusion adoption in gastric surgery
7.7%
55%
0.049
Single-unit transfusion adoption in liver surgery
17.6%
58.3%
0.04
Key Findings
After PBM implementation, the number of transfused patients per year significantly decreased.
Transfusion rates decreased notably in liver and gastric surgeries, with a strong trend in pancreatic surgery; colorectal surgery rates remained unchanged.
Preoperative hemoglobin was significantly higher in patients who did not require transfusions in both pre- and post-PBM groups.
The adoption of a single-unit transfusion strategy increased significantly post-PBM, especially in gastric and liver surgeries.
Postoperative complication rates remained similar before and after PBM implementation, indicating safety of the restrictive transfusion approach.
Clinical Implications
The PBM program effectively reduced red blood cell transfusions without increasing postoperative complications, supporting restrictive transfusion triggers and single-unit transfusions as safe practices. Preoperative optimization of hemoglobin levels remains critical to minimize transfusion needs. These findings encourage wider adoption of PBM protocols in abdominal oncologic surgeries to improve patient outcomes.
Conclusion
The introduction of a multidisciplinary PBM program in an Italian hospital significantly lowered transfusion rates in abdominal surgery patients, particularly in liver resections, without compromising postoperative outcomes. This supports PBM as an effective strategy to optimize blood use and patient safety.
References
Gruttadauria et al. 2018 -- Impact of Blood Transfusion on Liver Surgery Outcomes
PBM Guidelines and Implementation Studies 2010-2020
by Giorgio Ercolani, Leonardo Solaini, Fabrizio D’Acapito, Claudio Isopi, Carlo Alberto Pacilio, Cinzia Moretti, Vanessa Agostini, Alessandro Cucchetti
