Implementation of a personalized blood management program in cardiac surgery: A before-and-after study

Preoperative anemia and iron deficiency are common in patients undergoing cardiac surgery and are associated with increased transfusion requirements, morbidity, mortality, and healthcare costs. The implementation of Patient Blood Management (PBM) strategies remains challenging in routine clinical practice.

We conducted a single-center, retrospective before-and-after study including patients scheduled for elective on-pump cardiac surgery during one year before and one year after PBM implementation. The PBM protocol included preoperative anemia correction, reduction of intraoperative hemodilution, reinforcement of single-unit red blood cell (RBC) transfusion strategies, and postoperative iron supplementation. The primary outcome was the rate of RBC transfusion. Secondary outcomes included postoperative complications and cost analysis.

A total of 787 patients were included (377 pre-PBM and 410 post-PBM). Baseline characteristics were comparable, except for a lower preoperative hemoglobin level in the pre-PBM group (13.7 ± 1.7 vs. 14.0 ± 1.5 g/dL; p = 0.03). RBC transfusion rate decreased significantly (33% vs. 26%, p = 0.02), with a higher proportion of single-unit transfusions. The post-PBM group received less intraoperative fluids and maintained higher hemoglobin levels throughout hospitalization. In multivariable analysis, PBM implementation was independently associated with reduced transfusion risk (OR 0.58; 95% CI 0.40-0.86; p < 0.01). The estimated annual cost savings were €66,223. There was no significant difference in postoperative complications, including acute kidney injury, stroke, new-onset atrial fibrillation, and hospital length of stay.

Implementation of a pragmatic PBM program in cardiac surgery reduced RBC transfusions and healthcare costs without increasing postoperative complications.