Multimodal Patient Blood Management Program Based on a Three-pillar Strategy: A Systematic Review and Meta-analysis

Area of Science:

• Anesthesiology and Perioperative Medicine
• Transfusion Medicine
• Health Services Research

Background:

• Patient Blood Management (PBM) is a multidisciplinary approach focused on optimizing patient outcomes by managing anemia, minimizing blood loss, and enhancing tolerance to anemia.
• Effective PBM strategies are crucial for improving surgical patient care and reducing healthcare costs.

Purpose of the Study:

• To evaluate the effectiveness of a multidisciplinary, multimodal Patient Blood Management (PBM) program in reducing perioperative complications and improving clinical outcomes for surgical patients.
• To synthesize evidence from existing studies on the impact of comprehensive PBM on transfusion rates, complications, and mortality.

Main Methods:

• A systematic review and meta-analysis of 17 studies involving 235,779 surgical patients.
• Included studies addressed the three pillars of PBM: preoperative anemia management, cell salvage, and rational transfusion strategies.
• Data were analyzed to compare outcomes between patients receiving PBM and control groups.

Main Results:

• PBM implementation significantly reduced red blood cell transfusion rates by 39% (RR 0.61).
• A significant decrease was observed in the number of red blood cell units transfused per patient (-0.43 units).
• PBM was associated with reduced hospital length of stay, fewer complications (RR 0.80), and lower mortality rates (RR 0.89).

Conclusions:

• Comprehensive PBM programs addressing all three pillars are effective in reducing transfusion requirements, complications, and mortality in surgical patients.
• The findings support the widespread adoption of multimodal PBM strategies to improve surgical patient outcomes.
• This meta-analysis provides strong evidence for healthcare providers and executives to advocate for and implement PBM initiatives.