title: Implementation of patient blood management remains extremely variable in Europe and Canada: the NATA benchmark project: An observational study.
abstract: BACKGROUND
  Preoperative anaemia is associated with increased postoperative morbidity and mortality. Patient blood management (PBM) is advocated to improve patient outcomes.
  
  
  OBJECTIVE
  NATA, the 'Network for the advancement of patient blood management, haemostasis and thrombosis', initiated a benchmark project with the aim of providing the basis for educational strategies to implement optimal PBM in participating centres.
  
  
  METHODS
  Prospective, observational study with online data collection in 11 secondary and tertiary care institutions interested in developing PBM.
  
  
  METHODS
  Ten European centres (Austria, Spain, England, Denmark, Belgium, Netherlands, Romania, Greece, France, and Germany) and one Canadian centre participated between January 2010 and June 2011.
  
  
  METHODS
  A total of 2470 patients undergoing total hip (THR) or knee replacement, or coronary artery bypass grafting (CABG), were registered in the study. Data from 2431 records were included in the final analysis.
  
  
  METHODS
  Primary outcome measures were the incidence and volume of red blood cells (RBC) transfused. Logistic regression analysis identified variables independently associated with RBC transfusions.
  
  
  RESULTS
  The incidence of transfusion was significantly different between centres for THR (range 7 to 95%), total knee replacement (range 3 to 100%) and CABG (range 20 to 95%). The volume of RBC transfused was significantly different between centres for THR and CABG. The incidence of preoperative anaemia ranged between 3 and 40% and its treatment between 0 and 40%, the latter not being related to the former. Patient characteristics, evolution of haemoglobin concentrations and blood losses were also different between centres. Variables independently associated with RBC transfusion were preoperative haemoglobin concentration, lost volume of RBC and female sex.
  
  
  CONCLUSIONS
  Implementation of PBM remains extremely variable across centres. The relative importance of factors explaining RBC transfusion differs across institutions, some being patient related whereas others are related to the healthcare process. The results reported confidentially to each centre will allow them to implement tailored measures to improve their PBM strategies.
authors.affiliation: From the Department of Anesthesiology, Centre hospitalo-universitaire Brugmann, Université Libre de Bruxelles, Brussels, Belgium (PVDL), and Department of Anesthesiology, Centre hospitalier de l'Université de Montréal, Université de Montréal, Montréal, Québec, Canada (JFH).
authors.forename: Philippe
authors.initials: P
authors.lastname: Van der Linden
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Hardy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking / Q000379:methods* / Q000592:standards*; D001803:Blood Transfusion / Q000379:methods* / Q000592:standards*; D002170:Canada / Q000453:epidemiology; D019468:Disease Management; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies