Abstract：
OBJECTIVE: The aim of this study was to investigate the efficacy of a two-step patient blood management (PBM) program in red blood cell (RBC) transfusion requirements among patients undergoing elective cardiopulmonary bypass (CPB) surgery.
METHODS: Prospective, non-randomized, two-step protocol design.
METHODS: Cardiac surgery department of Clinique Pasteur, Toulouse, France.
METHODS: 897 patients undergoing for elective CPB surgery.
METHODS: We conducted a two-steps protocol: PBMe and PBMc. PBMe involved a short quality improvement program for health care workers, while PBMc introduced a systematic approach to pre- and postoperative correction of deficiencies, incorporating iron injections, oral vitamins, and erythropoiesis-stimulating agents.
METHODS: The PBM program\'s effectiveness was evaluated through comparison with a pre-PBM retrospective cohort after propensity score matching. The primary objective was the proportion of patients requiring RBC transfusions during their hospital stay. Secondary objectives were also analyzed.
RESULTS: After matching, 343 patients were included in each group. Primary outcomes were observed in 35.7% (pre-PBM), 26.7% (PBMe), and 21.1% (PBMc) of patients, resulting in a significant reduction (40.6%) in the overall RBC transfusion rate. Both the PBMe and PBMc groups exhibited significantly lower risks of RBC transfusion compared to the pre-PBM group, with adjusted odds ratios of 0.59 [95% CI 0.44-0.79] and 0.44 [95% CI 0.32-0.60], respectively. Secondary endpoints included reductions in transfusions exceeding 2 units, total RBC units transfused, administration of allogeneic blood products, and total bleeding volume recorded on Day 1. There were no significant differences noted in mortality rates or the duration of hospital stays.
CONCLUSIONS: This study suggests that health care education and systematic deficiency correction are associated with reduced RBC transfusion rates in elective CPB surgery. However, further randomized, controlled studies are needed to validate these findings and refine their clinical application.
METHODS: Prospective, non-randomized, two-step protocol design.
METHODS: Cardiac surgery department of Clinique Pasteur, Toulouse, France.
METHODS: 897 patients undergoing for elective CPB surgery.
METHODS: We conducted a two-steps protocol: PBMe and PBMc. PBMe involved a short quality improvement program for health care workers, while PBMc introduced a systematic approach to pre- and postoperative correction of deficiencies, incorporating iron injections, oral vitamins, and erythropoiesis-stimulating agents.
METHODS: The PBM program\'s effectiveness was evaluated through comparison with a pre-PBM retrospective cohort after propensity score matching. The primary objective was the proportion of patients requiring RBC transfusions during their hospital stay. Secondary objectives were also analyzed.
RESULTS: After matching, 343 patients were included in each group. Primary outcomes were observed in 35.7% (pre-PBM), 26.7% (PBMe), and 21.1% (PBMc) of patients, resulting in a significant reduction (40.6%) in the overall RBC transfusion rate. Both the PBMe and PBMc groups exhibited significantly lower risks of RBC transfusion compared to the pre-PBM group, with adjusted odds ratios of 0.59 [95% CI 0.44-0.79] and 0.44 [95% CI 0.32-0.60], respectively. Secondary endpoints included reductions in transfusions exceeding 2 units, total RBC units transfused, administration of allogeneic blood products, and total bleeding volume recorded on Day 1. There were no significant differences noted in mortality rates or the duration of hospital stays.
CONCLUSIONS: This study suggests that health care education and systematic deficiency correction are associated with reduced RBC transfusion rates in elective CPB surgery. However, further randomized, controlled studies are needed to validate these findings and refine their clinical application.
摘要：
目的：本研究的目的是探讨在接受择期体外循环（CPB）手术的患者中，采用两步法的患者血液管理（PBM）方案对红细胞（RBC）输血需求的影响。
方法：前瞻性，非随机化，两步协议设计。
方法：CliniquePasteur心脏外科，图卢兹,法国。
方法：897例接受择期CPB手术的患者。
方法：我们进行了两步方案：PBMe和PBMc。PBMe参与了针对医护人员的短期质量改进计划，虽然PBMC引入了一种系统的方法来纠正缺陷的术前和术后，加入铁注射液，口服维生素,和红细胞生成刺激剂。
方法：通过与倾向评分匹配后的PBM前回顾性队列比较，评估了PBM计划的有效性。主要目标是住院期间需要输血的患者比例。次要目标也进行了分析。
结果：匹配后，每组343例患者。主要结局为35.7%（PBM前），26.7%（PBMe），和21.1％（PBMC）的患者，导致整体RBC输血率显着降低（40.6％）。与PBM前的组相比，PBMe和PBMC组的红细胞输血风险均明显降低。调整后的赔率比为0.59[95%CI0.44-0.79]和0.44[95%CI0.32-0.60]，分别。次要终点包括输血减少超过2个单位，总红细胞单位输注，同种异体血液制品的管理，和在第1天记录的总出血量。死亡率或住院时间没有显着差异。
结论：这项研究表明，在选择性CPB手术中，健康护理教育和系统缺陷纠正与降低红细胞输血率相关。然而,进一步随机化，需要对照研究来验证这些发现并完善其临床应用。
方法：前瞻性，非随机化，两步协议设计。
方法：CliniquePasteur心脏外科，图卢兹,法国。
方法：897例接受择期CPB手术的患者。
方法：我们进行了两步方案：PBMe和PBMc。PBMe参与了针对医护人员的短期质量改进计划，虽然PBMC引入了一种系统的方法来纠正缺陷的术前和术后，加入铁注射液，口服维生素,和红细胞生成刺激剂。
方法：通过与倾向评分匹配后的PBM前回顾性队列比较，评估了PBM计划的有效性。主要目标是住院期间需要输血的患者比例。次要目标也进行了分析。
结果：匹配后，每组343例患者。主要结局为35.7%（PBM前），26.7%（PBMe），和21.1％（PBMC）的患者，导致整体RBC输血率显着降低（40.6％）。与PBM前的组相比，PBMe和PBMC组的红细胞输血风险均明显降低。调整后的赔率比为0.59[95%CI0.44-0.79]和0.44[95%CI0.32-0.60]，分别。次要终点包括输血减少超过2个单位，总红细胞单位输注，同种异体血液制品的管理，和在第1天记录的总出血量。死亡率或住院时间没有显着差异。
结论：这项研究表明，在选择性CPB手术中，健康护理教育和系统缺陷纠正与降低红细胞输血率相关。然而,进一步随机化，需要对照研究来验证这些发现并完善其临床应用。
