Outcomes, cost-effectiveness, and ethics in patient blood management.

IF 2.3 3区 医学 Q2 ANESTHESIOLOGY
Current Opinion in Anesthesiology Pub Date : 2025-04-01 Epub Date: 2025-02-12 DOI:10.1097/ACO.0000000000001466
Daniel Bolliger, Andreas Buser, Kenichi A Tanaka
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引用次数: 0

Abstract

Purpose of the review: In this narrative review, we evaluate the recent evidence for benefits, cost-effectiveness, and ethical considerations of patient blood management (PBM) programs.

Recent findings: PBM programs are able to reduce the amount of red blood cell transfusion by 20-40% and the risk of reoperation. Lower morbidity and mortality due to PBM implementation were only shown in retrospective studies with a before-and-after design but not in randomized controlled trials. PBM is very likely to be cost-effective when reduced blood transfusion can be accomplished through low-cost interventions, such as administration of oral iron or antifibrinolytics. Further, cost-efficacy can also be achieved by reducing postoperative morbidity and length of hospital stay. Of note, cost-efficacy of PBM interventions might be better in patients at high bleeding risk. Finally, aiming to improve patient's outcome while minimizing transfusion-induced complications, PBM seems highly ethical.

Summary: PBM is an important concept as it promotes the rational use of allogeneic blood products and reduces transfusion and wastage of precious and limited blood products.

患者血液管理的结果、成本效益和伦理。
本综述的目的:在这篇叙述性综述中,我们评估了最近关于患者血液管理(PBM)项目的益处、成本效益和伦理考虑的证据。最近的研究发现:PBM项目能够减少20-40%的红细胞输注量和再次手术的风险。实施PBM的低发病率和死亡率仅在前后设计的回顾性研究中显示,而在随机对照试验中没有显示。当可以通过低成本的干预措施(如口服铁或抗纤溶药物)来减少输血时,PBM很可能具有成本效益。此外,成本效益也可以通过减少术后发病率和住院时间来实现。值得注意的是,在高出血风险的患者中,PBM干预的成本效益可能更好。最后,旨在改善患者的预后,同时尽量减少输血引起的并发症,PBM似乎是高度道德的。摘要:PBM是一个重要的概念,因为它促进了异体血液制品的合理使用,减少了宝贵和有限的血液制品的输血和浪费。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.90
自引率
8.00%
发文量
207
审稿时长
12 months
期刊介绍: ​​​​​​​​Published bimonthly and offering a unique and wide ranging perspective on the key developments in the field, each issue of Current Opinion in Anesthesiology features hand-picked review articles from our team of expert editors. With fifteen disciplines published across the year – including cardiovascular anesthesiology, neuroanesthesia and pain medicine – every issue also contains annotated references detailing the merits of the most important papers.
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