Reduction of red blood cell transfusion with a patient blood management protocol in urological and visceral surgery: a before-after study

Background

Although Patient Blood Management (PBM) is recommended by international guidelines, little evidence of its effectiveness exists in abdominal surgery. The aim of this study was to evaluate the benefits of the implementation of a PBM protocol on transfusion incidence and anaemia-related outcomes in major urological and visceral surgery.

Methods

In this before-after study, a three-pillar PBM protocol was implemented in 2020–2021 in a tertiary care centre, including preoperative correction of iron-deficiency anaemia, intraoperative tranexamic acid administration, and postoperative restrictive transfusion. A historical cohort (2019) was compared to a prospective cohort (2022) after the implementation of the PBM protocol. The primary outcome was the incidence of red blood cell transfusion intraoperatively or within 7 days after surgery.

Results

Data from 488 patients in the historical cohort were compared to 499 patients in the prospective cohort. Between 2019 and 2022, screening for iron deficiency increased from 13.9% to 69.8% (p < 0.01), tranexamic acid administration increased from 9.5% to 84.6% (p < 0.01), and median haemoglobin concentration before transfusion decreased from 77 g.L⁻¹ to 71 g.L⁻¹ (p = 0.02). The incidence of red blood cell transfusion decreased from 11.5% in 2019 to 6.6% in 2022 (relative risk 0.58, 95% CI 0.38−0.87, p = 0.01). The incidence of haemoglobin concentration lower than 100 g.L⁻¹ at discharge was 24.2% in 2019 and 21.8% in 2022 (p =  0.41). The incidence of medical complications was comparable between the groups.

Conclusion

The implementation of a PBM protocol over a two-year period was associated with a reduction of transfusion in major urological and visceral surgery.