Clinical Scorecard: Evaluating the Effectiveness of Patient Blood Management Strategies in an Italian City Hospital: Impact on Red Blood Cell Transfusion Rates

At a Glance

Key Highlights

• Blood transfusions are common in major abdominal surgeries but are associated with increased postoperative morbidity and mortality, especially when two or more units are transfused.
• PBM program introduction in 2018 led to a significant reduction in transfusion rates, particularly in gastric, pancreatic, and liver surgeries.
• The PBM protocol emphasized restrictive hemoglobin transfusion triggers, single-unit transfusions, multidisciplinary collaboration, and continuous education and audits.

Guideline-Based Recommendations

Diagnosis

• Assess preoperative hemoglobin, platelet count, and INR to evaluate anemia and bleeding risk.
• Use ASA score and malignancy diagnosis to stratify patient risk.

Management

• Implement PBM protocols based on three pillars: preoperative optimization, intraoperative blood conservation, and postoperative anemia management.
• Adopt restrictive transfusion triggers tailored to patient conditions and comorbidities.
• Use single-unit transfusion practices with reassessment before additional units.
• Engage multidisciplinary teams including surgeons, anesthesiologists, and transfusion specialists.

Monitoring & Follow-up

• Conduct periodic audits of transfusion practices.
• Monitor hemoglobin levels perioperatively to guide transfusion decisions.
• Track postoperative complications and length of hospital stay.

Risks

• Excessive transfusion increases risk of postoperative morbidity and mortality.
• Intraoperative transfusions are linked to higher rates of major postoperative complications and longer hospital stays.

Patient & Prescribing Data

1302 patients undergoing elective abdominal tumor surgeries from 2017 to 2020

Post-PBM implementation, transfusion rates decreased significantly, with increased use of single-unit transfusions and restrictive hemoglobin triggers, improving early postoperative outcomes.

Clinical Best Practices

• Establish a multidisciplinary PBM working group with clear leadership and hospital management support.
• Apply a blood transfusion management algorithm incorporating restrictive triggers and single-unit transfusions.
• Provide ongoing education and group discussions for surgical and anesthesia teams.
• Regularly audit transfusion practices to ensure adherence to PBM protocols.
• Tailor transfusion decisions to individual patient comorbidities and clinical status.

References

• Blood transfusions in surgery and associated risks
• Patient Blood Management principles and guidelines