Ana Belén Ortega López
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Estefanía Morente Constantin
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Pablo Romero Garcia
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Maria Almudena Garcia Ruiz
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Encarnación Moreno Abril
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...
Abstract
INTRODUCTION
Allogeneic red blood cell (RBC) transfusions are vital and effective and effective to treat anemia. RBC transfusions increase hospitalizations in 2.5 days, risk of death in 1.7 times and risk of infection in 1.9 times. The cost of discharges from the hospital is 1.83 times higher and it represents 7.8% of the hospitalization total expenses. However, there is little awareness and knowledge about this transfusion practice, as well as an inexplicable and enormous inter-center variability.
In attempt to reduce unnecessary transfusions and improve postoperative evolution, as well as to reduce hospital costs, "Patient Blood Management" (PBM) program has been developed, which includes hospital policies, procedures and protocols. In literature, evidence of PBM programs effectiveness is growing.
METHOD
In view of the need to evaluate these issues, the Maturity Assessment Patient Blood Management (MAPBM) project was constituted in 2014, which involves a group of clinical and management experts nationwide, with the participation of 35 Spanish hospitals (including our center since 2015). It evaluates and compares:The knowledge of professionals about transfusion practice and PBM programs (anonymous survey). Figure 1.The PBM process indicators of each participating center. Figure 2.Inter-transfusion variability and factors related to transfusion in different procedures adjusted by age, sex and comorbidity. Figure 3
We will analyze the results of our center comparing them with the rest of hospitals.
RESULTS
In general, there is a high awareness of the indication and minimization of transfusions in different procedures, as well as a dissemination of our PBM programs above the average, especially the protocol of preoperative anemia (Figure 1).
Despite this, the results of our circuit for the correction of preoperative anemia are unfavorable, since they are detected in a higher percentage than the rest of the centers, but they are not effectively treated in the studied procedures (Figure 2).
Our strategies to minimize bleeding, both spinal anesthesia in orthopedic and traumatological surgeries and perioperative use of tranexamic acid are noteworthy, except in the cases of hip fracture surgeries, where its use was contraindicated by multidisciplinary consensus.
Our transfusion threshold is close to the standard. In all the studied procedures, transfusion with Hb ≥ 8gr / dl is not considered.
Regarding the results of transfusion and factors related to transfusion (Figure 3), a globally superior transfusion rate is observed, mainly at the expense of cardiac and open colorectal surgery.
Regarding other items, our mortality and complications rates are, in general, unfavorable. However, hospitalizations and readmissions are lower.
CONCLUSIONS
Although the dissemination of our PBM strategies is adequate, its implementation has not meant an improvement in the transfusion rate of the procedures studied, being even higher than the expected rate.
We assume that the lack of efficacy of the circuit for the correction of preoperative anemia is due to the intrinsic obstacles of our center. Among them:Premature programming in some patients, especially the case of cardiovascular surgery, which determines that the time between the surgical indication and the preoperative visit, is very limited.Lack of adequacy of the treatment at the date of intervention caused by lack of knowledge, especially in general surgery.The rigid criteria for the delivery of carboxymaltose iron limit the inclusion of patients who are closer to the intervention date, or determine an insufficient dosage of iron sucrose.Lack of diffusion of our program to different services when correcting postoperative anemia with iron.
Strategies will be established by the Transfusion commission to solve the problems identified.
As for the unfavorable results on transfusion practice (transfusion index, mortality and complications), it is essential to introduce improvements and update the optimal use of blood products by our professionals.
This contradicts the results of the Transfusion Practice Survey. Therefore, we will take this data with caution, insisting on the awareness of adequate transfusion policies and PBM strategies, with the support of the hospital's management, and the dissemination of knowledge about these programs to achieve the commitment of the professionals involved.
Disclosures
No relevant conflicts of interest to declare.
Seeking Strategies to Optimize Blood Utilization: The Preliminary Experience with Implementing a Patient Blood Management Program in a Greek Tertiary Hospital