Zeitschrift für Anästhesiologie und Schmerzforschung

Introduction to Patient Blood Management in Clinical Practice at a Local-Regional Hospital: A Statistical In-Process Control of Anaemia and Transfusion Incidence in Knee and Hip Arthroplasty

Abstract

Casutt M, Lengkong-Bode M, Kaufmann T, Schuepfer G, Konrad C and Ockert S

Background: The aim of this study was to determine the influence of an active patient blood management (PBM) program in orthopedic surgery in clinical practice at a loco regional hospital.
Methods: After introduction of the PBM program in July 2013, we performed a statistical in-process control for the period between May 2012 and December 2014. The period between May 2012 and June 2013 was before the introduction of the PBM program and the period between July 2013 and December 2014 was after its introduction. During the observation 766 elective orthopedic operations were analyzed (489 hip and 277 knee prostheses). Preoperative anemia, blood transfusion rates and hospital stay were examined.
Results: There was no statistically significant change in preoperative anemia. Using statistical process control (SPC) techniques, we documented an impressive change in the system with a relevant decline of perioperative transfusion rate as a non-random change in the ongoing process. Transfusion probability was reduced risk adjusted by 53% from 7.4% to 3.5% (p=0.008) and length of hospital stay (LOS) dropped, risk adjusted from 9.6 to 9.0 days (p<0.001).
Conclusion: Initiation of a preoperative anemia-correction algorithm within the scope of a PBM-program in clinical routine with the inclusion of general practitioners in a regional hospital was effective in regard to a decrease in blood transfusion risk and in LOS.