Perioperative Patient Blood Management and Outcomes in Major Elective Orthopaedic Surgery
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Document Type
Document Version
Director
Torre Fornell, Rafael de la
García-Altés, Anna
Bisbe, Elvira
García-Altés, Anna
Bisbe, Elvira
Tutor
Torre Fornell, Rafael de la
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Publication Date
Pages
168 p.
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Citation
Garcia Casanovas, A. Perioperative Patient Blood Management and Outcomes in Major Elective Orthopaedic Surgery. Universitat Pompeu Fabra; 2025. handle: http://hdl.handle.net/10803/695314
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Citation
Doctoral program
Universitat Pompeu Fabra. Doctorat en Biomedicina
Abstract
Antecedents: Les estratègies de Patient Blood Management (PBM) són considerades una bona pràctica en cirurgies amb alt risc de sagnat; no obstant això, el coneixement sobre la pràctica clínica actual i el seu impacte en els resultats en els pacients és limitat. Mètodes: Es va seguir un disseny de cohort retrospectiu multicèntric, combinant l’anàlisi a nivell d’hospital i de pacient. L’estudi va incloure pacients intervinguts d’artroplàstia primària de genoll o maluc entre el gener de 2016 i el desembre de 2022 en 47 hospitals d’Espanya. La via clínica de PBM en el procés perioperatori va comprendre nou intervencions basades en les recomanacions de les guies, i el seu compliment es va analitzar amb un indicador compost de qualitat. Es van avaluar les complicacions postoperatòries als 30 dies, l’estada hospitalària i l’ús de transfusió sanguínia. L’associació entre el nivell de compliment i els resultats es va estimar mitjançant models de regressió multivariable multinivell. Resultats: Els hospitals van aplicar el 62% de les recomanacions en PBM, i només el 12% dels pacients van rebre l’atenció de manera íntegra. Les intervencions amb més variabilitat van ser el cribratge preoperatori del metabolisme del ferro i la transfusió d’una sola unitat. Un major compliment es va associar amb un 57% menys de probabilitat de tenir complicacions postoperatòries als 30 dies, estades hospitalàries més curtes i menor necessitat de transfusions. Conclusions: El seguiment de les recomanacions en PBM va ser subòptim, amb una elevada variació entre hospitals. Un major grau d’adequació es va associar amb millors resultats en pacients sotmesos a artroplàsties de genoll i maluc.
Background: Patient Blood Management (PBM) strategies are considered the best practice for high-risk bleeding surgeries; however, knowledge of current practices and their impact on patient outcomes is limited. Methods: This research followed a retrospective multicentre cohort design combining hospital- and patient-level analyses. The study included patients who underwent elective primary total knee or hip arthroplasty between 1 January 2016 and 31 December 2022 across 47 hospitals in Spain. The PBM clinical pathway consisted of nine major guideline-recommended interventions, with adherence measured using a composite quality indicator. Endpoints included 30-day postoperative complications, length of hospital stay, and red blood cell utilisation. Multilevel multivariable regression models were used to assess the association between PBM adherence and the outcomes. Results: Hospitals provided 62% of the recommended PBM care, with only 12% of patients receiving the complete PBM clinical pathway. The greatest variability occurred in preoperative iron screening and single-unit transfusion. Higher per-patient adherence to the PBM pathway was associated with 57% lower odds of 30-day postoperative complications, shorter hospital stays, and reduced transfusion requirements. Conclusions: Adherence to perioperative recommended PBM care was suboptimal, with considerable variation across hospitals. Higher adherence was associated with improved outcomes in patients undergoing total knee and hip arthroplasties.
Background: Patient Blood Management (PBM) strategies are considered the best practice for high-risk bleeding surgeries; however, knowledge of current practices and their impact on patient outcomes is limited. Methods: This research followed a retrospective multicentre cohort design combining hospital- and patient-level analyses. The study included patients who underwent elective primary total knee or hip arthroplasty between 1 January 2016 and 31 December 2022 across 47 hospitals in Spain. The PBM clinical pathway consisted of nine major guideline-recommended interventions, with adherence measured using a composite quality indicator. Endpoints included 30-day postoperative complications, length of hospital stay, and red blood cell utilisation. Multilevel multivariable regression models were used to assess the association between PBM adherence and the outcomes. Results: Hospitals provided 62% of the recommended PBM care, with only 12% of patients receiving the complete PBM clinical pathway. The greatest variability occurred in preoperative iron screening and single-unit transfusion. Higher per-patient adherence to the PBM pathway was associated with 57% lower odds of 30-day postoperative complications, shorter hospital stays, and reduced transfusion requirements. Conclusions: Adherence to perioperative recommended PBM care was suboptimal, with considerable variation across hospitals. Higher adherence was associated with improved outcomes in patients undergoing total knee and hip arthroplasties.
Keywords
Patient blood management, Patient blood management, Patient blood management, Complicacions postoperatòries, Postoperative complications, Complicaciones postoperatorias, Artroplàstia, Arthroplasty, Artroplastia, Cirugia ortopèdica, Orthopaedic surgery, Cirugía ortopédica, Indicadors de qualitat, Quality indicators, Indicadores de calidad
Subjects
61 - Medicine
Publisher
Universitat Pompeu Fabra
