Patient Blood Management improves outcome in oncologic surgery

Abstract

Background: Patient Blood Management (PBM) is a systematic quality improving clinical model to reduce anemia and avoid transfusions in all kinds of clinical settings. Here, we investigated the potential of PBM in oncologic surgery and hypothesized that PBM improves 2-year overall survival (OS). Methods: Retrospective analysis of patients 2years before and after PBM implementation. The primary endpoint was OS at 2years after surgery. We identified a sample size of 824 to detect a 10% improvement in survival in the PBM group. Results: The analysis comprised of 836 patients that underwent oncologic surgery, 389 before and 447 after PBM, was implemented. Patients in the PBM+ presented significantly more frequent with normal hemoglobin values before surgery than PBM- (56.6 vs. 35.7%; p<0.001). The number of transfusions was significantly reduced from 5.5±11.1 to 3.0±6.9units/patient (p<0.001); moreover, the percentage of patients being transfused during the clinic stay was significantly reduced from 62.4 to 40.9% (p<0.001). Two-year OS was significantly better in the PBM+ and increased from 67.0 to 80.1% (p=0.001). A normal hemoglobin value (>12g/dl in female and >13g/dl in male) before surgery (HR 0.43, 95% CI 0.29-0.65, p<0.001) was the only independent predictive factor positively affecting survival. Conclusions: PBM is a quality improvement tool that is associated with better mid-term surgical oncologic outcome. The root cause for improvement is the increase of patients entering surgery with normal hemoglobin values.