Patient Blood Management in Orthopedic Surgery-Prospective Study

Dr. Muskan Chaudhary, Dr. Bheem Singh Meena, Dr. Anshul Bansal

Abstract: Introduction: Patient Blood Management (PBM) is a multimodal, multidisciplinary approach done to limit the use and the need for allogeneic blood transfusion along with improving their clinical outcomes. PBM usually refers to surgical patients; its clinical use has evolved. Randomized trials show that patients do well when given less blood, remaining an impression that orthopedic surgery patients require a higher hemoglobin transfusion threshold than other patient. Material and Methods: After patient blood management program, we prospectively evaluated all orthopedic patients, comparing transfusion practices and clinical outcomes in the pre- and post-blood management in surgical cases. Risk adjustment accounted for sex, age, surgical procedure, and case mix index. Results: After patient blood management was implemented, the mean hemoglobin threshold decreased from 7.6 ? 1.0 g/dl to 6.9 ? 1.0 g/dl (P < 0.0001). Clinical outcomes do improved, with decreased morbidity (from 1.4% to 0.55%; P = 0.01), composite morbidity or mortality, and 30-day readmissions decreased. Improved outcomes were primarily recognized in patients 60 yr of age and older. Conclusions: In a prospective study, patient blood management was associated with reduced blood use with improved clinical or almost similar outcomes in orthopedic surgery. A hemoglobin threshold of 7g/dl appears to be safe.

Keywords: PBM, Prospective, haemoglobin threshold, orthopedics