title: [Implementation of blood sparing programs in Spain: results of a survey of departments of anesthesiology and resuscitation].
abstract: The objective of this article is to determine the availability of a perioperative transfusion management program (Patient Blood Management [PBM]) in various hospitals through a survey that included a description of the preanesthesia visit, the availability and use of the various blood-sparing techniques and the factors limiting their implementation in elective surgery. The survey included 42 questions, directed at the representative departments of anesthesiology of hospitals in Spain (n=91). The survey was conducted from September to November 2012. We analyzed the 82 surveys in which all the questions were answered (90%). Preoperative consultations are routinely performed (>70%) in 87% of the hospitals. The time from the consultation to surgery varied between 1 week and 2 months for 74% of the patients scheduled for orthopedic or trauma surgery, 78% of those scheduled for oncologic surgery and 77% of those scheduled for cardiac surgery. Almost all hospitals (77, 94%) had a transfusion committee, and 90% of them had an anesthesiologist on the committee. Seventy-nine percent of the hospitals had a blood-sparing program, and the most widely used technique was the use of antifibrinolytic agents (75% of hospitals), followed by intraoperative and postoperative blood recovery in equal proportions (67%). Optimization of preoperative hemoglobin was routinely performed with intravenous iron in 39% of the hospitals and with recombinant erythropoietin in 28% of the hospitals. The absence of a well-established circuit and the lack of involvement and collaboration with the surgical team were the main limiting factors in implementing PBM. Currently, the implementation of PBM in Spain could be considered acceptable, but it could also be improved, especially in the treatment of preoperative anemia. The implementation of PBM requires multidisciplinary collaboration among all personnel responsible for perioperative care, including the health authorities.
authors: Servicio de Anestesiología y Reanimación, Hospital Universitario Vall d'Hebron, Barcelona, España. Electronic address: mjcolomina@vhebron.net.
authors: M J
authors: MJ
authors: Colomina
authors: Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España.
authors: M
authors: M
authors: Basora Macaya
authors: Servicio de Anestesiología y Reanimación, Hospital del Mar, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, España.
authors: E
authors: E
authors: Bisbe Vives
mesh_terms: D000740:Anemia / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D000776:Anesthesiology; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D001771:Blood Banks / Q000458:organization & administration / Q000706:statistics & numerical data*; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D001804:Blood Transfusion, Autologous / Q000706:statistics & numerical data; D004921:Erythropoietin / Q000627:therapeutic use; D019538:Health Care Surveys; D006397:Hematinics / Q000627:therapeutic use; D006454:Hemoglobins / Q000032:analysis; D006748:Hospital Departments; D006801:Humans; D007501:Iron / Q000008:administration & dosage / Q000627:therapeutic use; D057725:Operative Blood Salvage / Q000706:statistics & numerical data; D016134:Organizational Policy; D019990:Perioperative Care / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D019106:Postoperative Hemorrhage / Q000628:therapy; D011367:Professional Staff Committees / Q000706:statistics & numerical data; D011994:Recombinant Proteins / Q000627:therapeutic use; D013030:Spain
chemical_list: D000933:Antifibrinolytic Agents; D006397:Hematinics; D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin; D007501:Iron
keywords: Alternativas a la transfusión; Alternatives to transfusion; Anemia preoperatoria; Blood-sparing techniques; Gestión de la transfusión; Perioperative anemia; Transfusion management; Técnicas de ahorro de sangre