Comprehensive perioperative blood management in patients undergoing elective bypass cardiac surgery: Benefit effect of health care education and systematic correction of iron deficiency and anemia on red blood cell transfusion

• Published in: Journal of clinical anesthesia 2024-11, Vol.98, p.111560, Article 111560
• Main Authors: Charbonneau, Hélène, Savy, Stéphanie, Savy, Nicolas, Pasquié, Marie, Mayeur, Nicolas, Angles, Olivier, Balech, Vincent, Berthelot, Anne-Laure, Croute-Bayle, Madeleine, Decramer, Isabelle, Duterque, David, Julien, Valerie, Mallet, Laurent, M'rini, Mimoun, Quedreux, Jean-François, Richard, Benoit, Sidobre, Laurent, Taillefer, Laurence, Thibaud, Adrien, Abouliatim, Issam, Berthoumieu, Pierre, Garcia, Olivier, Soula, Philippe, Vahdat, Olivier, Breil, Claude, Brunel, Pierre, Sciacca, Giovanni
• Format: Article
• Language: English
• Subjects: Acids; Aged; Anemia; Anemia - therapy; Anemia, Iron-Deficiency - prevention & control; Blood; Cardiac Surgical Procedures - adverse effects; Cardiopulmonary Bypass - adverse effects; Clinical outcomes; Consent; Drug therapy; Drug withdrawal; Education; Elective cardiac surgery; Elective Surgical Procedures - adverse effects; Erythrocyte Transfusion - statistics & numerical data; Erythropoiesis-stimulating agent; Female; France; Health education; Heart surgery; Hematinics - administration & dosage; Hemoglobin; Human health and pathology; Humans; Hypotheses; Intervention; Iron; Iron - administration & dosage; Iron Deficiencies; Iron deficiency; Length of Stay - statistics & numerical data; Life Sciences; Male; Medical personnel; Middle Aged; Mortality; Patients; Perioperative care; Perioperative Care - methods; Prospective Studies; Quality Improvement; Red blood cell transfusion; Retrospective Studies; Surgery; Vitamin B
• ISSN: 0952-8180; 1873-4529; 1873-4529
• DOI: 10.1016/j.jclinane.2024.111560

The aim of this study was to investigate the efficacy of a two-step patient blood management (PBM) program in red blood cell (RBC) transfusion requirements among patients undergoing elective cardiopulmonary bypass (CPB) surgery. Prospective, non-randomized, two-step protocol design. Cardiac surgery department of Clinique Pasteur, Toulouse, France. 897 patients undergoing for elective CPB surgery. We conducted a two-steps protocol: PBMe and PBMc. PBMe involved a short quality improvement program for health care workers, while PBMc introduced a systematic approach to pre- and postoperative correction of deficiencies, incorporating iron injections, oral vitamins, and erythropoiesis-stimulating agents. The PBM program's effectiveness was evaluated through comparison with a pre-PBM retrospective cohort after propensity score matching. The primary objective was the proportion of patients requiring RBC transfusions during their hospital stay. Secondary objectives were also analyzed. After matching, 343 patients were included in each group. Primary outcomes were observed in 35.7% (pre-PBM), 26.7% (PBMe), and 21.1% (PBMc) of patients, resulting in a significant reduction (40.6%) in the overall RBC transfusion rate. Both the PBMe and PBMc groups exhibited significantly lower risks of RBC transfusion compared to the pre-PBM group, with adjusted odds ratios of 0.59 [95% CI 0.44–0.79] and 0.44 [95% CI 0.32–0.60], respectively. Secondary endpoints included reductions in transfusions exceeding 2 units, total RBC units transfused, administration of allogeneic blood products, and total bleeding volume recorded on Day 1. There were no significant differences noted in mortality rates or the duration of hospital stays. This study suggests that health care education and systematic deficiency correction are associated with reduced RBC transfusion rates in elective CPB surgery. However, further randomized, controlled studies are needed to validate these findings and refine their clinical application. •A quality improvement program for healthcare workers reduces the need for RBC transfusions.•Screening and correcting anemia are mandatory to improve hemoglobin levels.•The best way to optimize RBC transfusion saving is to combine several pre, per and postoperative programs. [Display omitted]