• Patrick Meybohm, Elke Schmitt, Suma Choorapoikayil, Lotta Hof, Oliver Old, Markus M Müller, Christof Geisen, Erhard Seifried, Olaf Baumhove, Samuel de Leeuw van Weenen, Alexandra Bayer, Patrick Friederich, Brigitte Bräutigam, Jens Friedrich, Matthias Gruenewald, Gunnar Elke, Gerd P Molter, Diana Narita, Ansgar Raadts, Christoph Haas, Klaus Schwendner, Andrea U Steinbicker, Dana J Jenke, Josef Thoma, Viola Weber, Markus Velten, Maria Wittmann, Henry Weigt, Björn Lange, Eva Herrmann, Kai Zacharowski, and German Patient Blood Management Network Collaborators.
• Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany; University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg, Germany. Electronic address: meybohm_p@ukw.de.
• Br J Anaesth. 2023 Sep 1; 131 (3): 472481472-481.

BackgroundPatient Blood Management (PBM) is a patient-centred, systematic, evidence-based approach to improve patient outcomes by managing and preserving a patient's own blood whilst promoting patient safety and empowerment. The effectiveness and safety of PBM over a longer period have not yet been investigated.MethodsWe performed a prospectively designed, multicentre follow-up study with non-inferiority design. Data were retrospectively extracted case-based from electronic hospital information systems. All in-hospital patients (≥18 yr) undergoing surgery and discharged between January 1, 2010 and December 31, 2019 were included in the analysis. The PBM programme focused on three domains: preoperative optimisation of haemoglobin concentrations, blood-sparing techniques, and guideline adherence/standardisation of allogeneic blood product transfusions. The outcomes were utilisation of blood products, composite endpoint of in-hospital mortality and postoperative complications (myocardial infarction/ischaemic stroke/acute renal failure with renal replacement therapy/sepsis/pneumonia), anaemia rate at admission and discharge, and hospital length of stay.ResultsA total of 1 201 817 (pre-PBM: n=441 082 vs PBM: n=760 735) patients from 14 (five university/nine non-university) hospitals were analysed. Implementation of PBM resulted in a substantial reduction of red blood cell utilisation. The mean number of red blood cell units transfused per 1000 patients was 547 in the PBM cohort vs 635 in the pre-PBM cohort (relative reduction of 13.9%). The red blood cell transfusion rate was significantly lower (P<0.001) with odds ratio 0.86 (0.85-0.87). The composite endpoint was 5.8% in the PBM vs 5.6% in the pre-PBM cohort. The non-inferiority aim (safety of PBM) was achieved (P<0.001).ConclusionsAnalysis of >1 million surgical patients showed that the non-inferiority condition (safety of Patient Blood Management) was fulfilled, and PBM was superior with respect to red blood cell transfusion.Clinical Trial RegistrationNCT02147795.Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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