Perioperative patient blood management program led and managed by anesthesiologists via a clinical pathway-focused approach: A single-center quality improvement study.

Abstract

Introduction: Despite its well-recognized benefits, patient blood management (PBM) during perioperative period has not yet been widely implemented due to a lack of coordinated management between surgical specialties and anesthesiologists.

Methods: An anesthesiologist-led perioperative PBM program was implemented across all surgical specialties at a general hospital in Taiwan using a clinical pathway-focused approach beginning on 1 April 2023. All in-hospital patients who received elective or emergency operations were included in this program. In addition to the 3-pillar PBM strategies, this program introduced the 3-domain clinical pathway approach (patient-centered, shared decision-making and point-of-care) to optimize blood transfusion and preserve patients' own blood, and established an institutional transfusion consensus. A defined period before PBM implementation (1 Jan 2023 to 31 Mar 2023) served as the control cohort, and the post-PBM period was defined as 1 Jan 2025 to 30 Sep 2025.

Results: Compared with the pre-PBM, perioperative RBC transfusions reduced from 849U/1000 surgeries to an average of 475U/1000 surgeries in the post-PBM period (% difference 0.374, 95% confidence interval [CI] 0.356 to 0.391; P < 0.001). Transfusions of other blood components were also significantly reduced by 67%. RBC transfusion rate reduced from 16.1% to 11.0% (relative risk 0.683, 95% CI 0.545-0.856; P = 0.001). Major postoperative complications and medical cost were lower after PBM implementation.

Conclusion: A comprehensive PBM program initiated by the anesthesia team during the perioperative period effectively reduces blood transfusion and selected postoperative quality indicators were lower after implementation across all surgical specialties.