title: Patient Blood Management is Associated With a Substantial Reduction of Red Blood Cell Utilization and Safe for Patient's Outcome: A Prospective, Multicenter Cohort Study With a Noninferiority Design.
abstract: To determine whether the implementation of patient blood management (PBM) is effective to decrease the use of red blood cell without impairment of patient's safety.
  
  
  
  The World Health Organization encouraged all member states to implement PBM programs employing multiple combined strategies to increase and preserve autologous erythrocyte volume to minimize red blood cell transfusions. Data regarding safety issues are not sufficiently available.
  
  
  
  In this prospective, multicenter study, surgical inpatients from four German University Hospitals were analyzed before (pre-PBM) and after the implementation of PBM. PBM program included multiple measures (ie, preoperative optimization of hemoglobin levels, blood-sparing techniques, and standardization of transfusion practice). Primary aim was to show noninferiority of the PBM cohort with a margin of 0.5%. Secondary endpoints included red blood cell utilization.
  
  
  
  A total of 129,719 patients discharged between July 2012 and June 2015 with different inclusion periods for pre-PBM (54,513 patients) and PBM (75,206 patients) were analyzed. The primary endpoint was 6.53% in the pre-PBM versus 6.34% in the PBM cohort. The noninferiority aim was achieved (P < 0.001). Incidence of acute renal failure decreased in the PBM cohort (2.39% vs 1.67%; P < 0.001, regression model). The mean number of red blood cell transfused per patient was reduced from 1.21 ± 0.05 to 1.00 ± 0.05 (relative change by 17%, P < 0.001).
  
  
  
  The data presented show that implementation of PBM with a more conscious handling of transfusion practice can be achieved even in large hospitals without impairment of patient's safety. Further studies should elucidate which PBM measures are most clinically and cost effective.
  
  
  
  PBM-Study ClinicalTrials.gov, NCT01820949.
authors.affiliation: *Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany†Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany‡Department of Anesthesiology, Intensive Care and Pain Medicine, University of Muenster, Muenster, Germany§Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany¶Department of Medicine, Institute of Biostatistics and Mathematical Modelling, Goethe University Frankfurt, Germany||German Red Cross Blood Transfusion Service Baden-Wuerttemberg - Hessen, Institute of Transfusion Medicine and Immunohematology, Frankfurt, Germany**Central Laboratory, University Hospital Frankfurt, Germany††Institute of Experimental Hematology and Transfusion Medicine, University of Bonn, Bonn, Germany‡‡Institute of Transfusion Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany§§Institute of Transfusion Medicine and Transplantation Immunology, University Hospital of Muenster, Muenster, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Meybohm
authors.forename: Eva
authors.initials: E
authors.lastname: Herrmann
authors.forename: Andrea U
authors.initials: AU
authors.lastname: Steinbicker
authors.forename: Maria
authors.initials: M
authors.lastname: Wittmann
authors.forename: Matthias
authors.initials: M
authors.lastname: Gruenewald
authors.forename: Dania
authors.initials: D
authors.lastname: Fischer
authors.forename: Georg
authors.initials: G
authors.lastname: Baumgarten
authors.forename: Jochen
authors.initials: J
authors.lastname: Renner
authors.forename: Hugo K
authors.initials: HK
authors.lastname: Van Aken
authors.forename: Christian F
authors.initials: CF
authors.lastname: Weber
authors.forename: Markus M
authors.initials: MM
authors.lastname: Mueller
authors.forename: Christof
authors.initials: C
authors.lastname: Geisen
authors.forename: Julia
authors.initials: J
authors.lastname: Rey
authors.forename: Dimitra
authors.initials: D
authors.lastname: Bon
authors.forename: Gudrun
authors.initials: G
authors.lastname: Hintereder
authors.forename: Suma
authors.initials: S
authors.lastname: Choorapoikayil
authors.forename: Johannes
authors.initials: J
authors.lastname: Oldenburg
authors.forename: Christian
authors.initials: C
authors.lastname: Brockmann
authors.forename: Raoul G
authors.initials: RG
authors.lastname: Geissler
authors.forename: Erhard
authors.initials: E
authors.lastname: Seifried
authors.forename: Kai
authors.initials: K
authors.lastname: Zacharowski
mesh_terms: D000740:Anemia / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D002985:Clinical Protocols; D065187:Controlled Before-After Studies; D017707:Erythrocyte Transfusion; D005260:Female; D005858:Germany; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D061214:Patient Safety; D018579:Patient Selection; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies
chemical_list: D006454:Hemoglobins