Abstract
Objective
To assess changes in inpatient transfusion utilization and patient outcomes with implementation
of a comprehensive patient blood management (PBM) program at a large US medical center.
Patients and Methods
This is an observational study of graduated PBM implementation for hospitalized adults
(age ≥18 years) from January 1, 2010, through December 31, 2017, at two integrated
hospital campuses at a major academic US medical center. Allogeneic transfusion utilization
and clinical outcomes were assessed over time through segmented regression with multivariable
adjustment comparing observed outcomes against projected outcomes in the absence of
PBM activities.
Results
In total, 400,998 admissions were included. Total allogeneic transfusions per 1000
admissions decreased from 607 to 405 over the study time frame, corresponding to an
absolute risk reduction for transfusion of 6.0% (95% confidence interval [CI]: 3.6%,
8.3%; P<.001) and a 22% (95% CI: 6%, 37%; P=.006) decrease in the rate of transfusions over projected. The risk of transfusion
decreased for all blood components except cryoprecipitate. Transfusion reductions
were experienced for all major surgery types except liver transplantation, which remained
stable over time. Hospital length of stay (multiplicative increase in geometric mean
0.85 [95% CI: 0.81, 0.89]; P<.001) and incident in-hospital adverse events (absolute risk reduction: 1.5% [95%
CI: 0.1%, 3.0%]; P=.04) were lower than projected at the end of the study time frame.
Conclusion
Patient blood management implementation for hospitalized patients in a large academic
center was associated with substantial reductions in transfusion utilization and improved
clinical outcomes. Broad-scale implementation of PBM in US hospitals is feasible without
signal for patient harm.
Abbreviations and Acronyms:
ARR (absolute risk reduction), CI (confidence interval), IQR (interquartile range), PBM (patient blood management), RBC (red blood cell)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: November 01, 2021
Footnotes
For editorial comment, see page 2936
Potential Competing Interests: Dr Kor is on the Scientific Advisory Board with Terumo Medical Corporation; and a consultant with Instrumentation Laboratory, UpToDate, and the National Institutes of Health. The remaining authors report no potential competing interests.
Grant Support: This study was supported by KL2 TR002379 (Dr Warner) from the National Center for Advancing Translational Science (NCATS), K23HL153310 (Dr Warner) from the National Heart, Lung, and Blood Institute (NHLBI), and grant HL121232 (Dr Kor) from NHLBI . Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health (NIH).
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