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Abstract：
Introduction: Patients who undergo surgery may require a blood transfusion and patients undergoing major colorectal surgery are more prone to preoperative and perioperative anemia. Blood transfusions have, however, long been associated with inflammatory and oncological complications. We aim to investigate the effects of an optimal implementation of a patient blood management (PBM) program in our hospital. Methods: This study retrospectively reviewed data from two different prospectively maintained databases of all patients undergoing elective major colorectal surgery with either a laparoscopic, open, or robotic approach from January 2017 to December 2022 at two different high-volume colorectal surgery Italian centers: the Colorectal Surgery Unit of Fondazione Policlinico Campus Bio-Medico in Rome and the Colorectal Surgery Unit of Fondazione Cardinale Panico in Tricase (Lecce). Our study compares the first group, also known as pre-PBM (January 2017-December 2018) and the second group, known as post-PBM (January 2021-December 2022). Results: A total of 2495 patients, who satisfied the inclusion and exclusion criteria, were included in this study, with, respectively, 1197 patients in the pre-PBM group and 1298 in the post- PBM group. The surgical approach was similar amongst the two groups, while the operative time was longer in the pre-PBM group than in the post-PBM group (273.0 ± 87 vs. 215.0 ± 124 min; p < 0.001). There was no significant difference in preparatory Hb levels (p = 0.486), while anemia detection was significantly higher post-PBM (p = 0.007). However, the rate of transfusion was drastically reduced since the implementation of PBM, with p = 0.032 for preoperative, p = 0.025 for intraoperative, and p < 0.001 for postoperative. Conclusions: We confirmed the need to reduce blood transfusions and optimize transfusion procedures to improve short-term clinical outcomes of patients. The implementation of the PBM program was associated with a significant reduction in the rate of perioperative transfusions and an increase in only appropriate transfusions.
摘要：
简介：接受手术的患者可能需要输血，接受大型结直肠手术的患者更容易发生术前和围手术期贫血。输血有，然而,长期以来与炎症和肿瘤并发症有关。我们的目的是研究在我们医院最佳实施患者血液管理（PBM）计划的效果。方法：这项研究回顾了来自两个不同的前瞻性维护数据库的数据，这些数据库包括所有接受腹腔镜择期大结直肠手术的患者，打开,或机器人方法从2017年1月至2022年12月在两个不同的高容量结直肠手术意大利中心：罗马的FondazionePoliclinicoCampusBio-Medico的结直肠外科部门和Tricase的FondazioneCardinalePanico的结直肠外科部门（Lecce）。我们的研究比较了第一组，也被称为pre-PBM（2017年1月-2018年12月）和第二组，称为后PBM（2021年1月至2022年12月）。结果:共2495例患者,满足纳入和排除标准的人，包括在这项研究中，with,分别,PBM前组有1197名患者，PBM后组有1298名患者。两组的手术方法相似，而PBM前的手术时间长于PBM后的手术时间（273.0±87vs.215.0±124分钟；p<0.001）。制备Hb水平无显著差异(p=0.486),而贫血检测显著高于PBM后(p=0.007)。然而,自实施PBM以来，输血率急剧下降，术前p=0.032，术中p=0.025，术后p<0.001。结论：我们证实有必要减少输血和优化输血程序，以改善患者的短期临床结局。PBM计划的实施与围手术期输血率的显着降低和仅适当输血的增加有关。
