German Patient Blood Management Network: effectiveness and safety analysis in 1.2 million patients

Meybohm, Patrick; Schmitt, Elke; Choorapoikayil, Suma; Hof, Lotta; Old, Oliver; Müller, Markus; Geisen, Christof; Seifried, Erhard; Baumhove, O; Weenen, Samuel de Leeuw van; Bayer, Alexandra; Friederich, Patrick; Bräutigam, Brigitte; Friedrich, Jens; Gruenewald, Matthias; Elke, Gunnar; Molter, G.; Nariţa, Diana; Raadts, Ansgar; Haas, Christoph; Schwendner, Klaus; Steinbicker, Andrea U.; Jenke, Dana Janina; Thoma, J.; Weber, Valerie; Velten, Markus; Weigt, Henry U.; Lange, Björn; Wittmann, Maria; Herrmann, Eva; Zacharowski, Kai

doi:10.1016/j.bja.2023.05.006

Cited by 15 publications

(4 citation statements)

References 23 publications

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“…This study included all patients aged ≥18 years who underwent non-obstetric surgery, were discharged from 14 German hospitals between January 1st, 2010, and December 31st, 2019, and had accessible preoperative Hb levels. Detailed methods have been published previously ( 15 ). Briefly, data were individually gathered from the electronic systems of participating hospitals, and supplemented with pharmacy and blood bank data by the local IT staff.…”

Section: Methodsmentioning

confidence: 99%

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Preoperative hemoglobin thresholds for survival equity in women and men

Rumpf,

Hof,

Old

et al. 2024

Front. Med.

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Anemia affects humans throughout life, and is linked to higher morbidity and mortality. Unclear is whether hemoglobin values are equivalent between women and men. This study evaluates the association of preoperative hemoglobin levels with in-hospital mortality and estimates thresholds for survival equity between men and women. All adult patients undergoing surgery between 2010 and 2019 from 14 German hospitals were included in the study. Thresholds for survival equity were determined with generalized additive models. In total, 842,130 patients with a median in-hospital follow-up time of 7 days were analyzed. During follow-up 20,370 deaths occurred. Preoperative hemoglobin stratified in-hospital mortality (log-rank test p < 0.001) and was associated with mortality independently of demographic risk, surgical risk and health status. For each 1 g/dL reduction in preoperative hemoglobin, the odds of mortality increased by a factor of 1.22 (95% CI 1.21–1.23, p < 0.001). A preoperative hemoglobin threshold of 10.5 g/dL reflected equivalent risk for both male and female patients. Hemoglobin levels below 10.5 g/dL had higher risk of mortality for women than for men. The findings from this study aid evidence-based thresholds, inform anemia management and promote equitable care, thus enhancing patient outcomes.

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Section: Methodsmentioning

confidence: 99%

“…The German Patient Blood Management Network provides a unique opportunity to evaluate preoperative Hb thresholds across a broad population of surgical patients ( 15 ). Access to data from more than 1 million patients enables data-driven estimation of outcome-based Hb thresholds.…”

Section: Introductionmentioning

confidence: 99%

Preoperative hemoglobin thresholds for survival equity in women and men

Rumpf,

Hof,

Old

et al. 2024

Front. Med.

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“…For example, a recent study in Germany used the records of 1.2 million patients to report a reduction in transfusion rate of 13.7% in the group who underwent active PBM. 16 There is an accumulating body of evidence demonstrating the benefits of tranexamic acid (TXA) in surgical patients reducing the risk of major surgical bleeding and transfusion by 25% with no increased risk of thrombosis. 17,18 Indeed, Roman et al concluded that TXA is the single most effective PBM intervention.…”

Section: Va R I Ation I N Tr a Nsfusion Ca R Ementioning

confidence: 99%

Harnessing the potential of data‐driven strategies to optimise transfusion practice

Evans,

Murphy,

Foy

et al. 2023

Br J Haematol

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SummaryNo one doubts the significant variation in the practice of transfusion medicine. Common examples are the variability in transfusion thresholds and the use of tranexamic acid for surgery with likely high blood loss despite evidence‐based standards. There is a long history of applying different strategies to address this variation, including education, clinical guidelines, audit and feedback, but the effectiveness and cost‐effectiveness of these initiatives remains unclear. Advances in computerised decision support systems and the application of novel electronic capabilities offer alternative approaches to improving transfusion practice. In England, the National Institute for Health and Care Research funded a Blood and Transplant Research Unit (BTRU) programme focussing on ‘A data‐enabled programme of research to improve transfusion practices’. The overarching aim of the BTRU is to accelerate the development of data‐driven methods to optimise the use of blood and transfusion alternatives, and to integrate them within routine practice to improve patient outcomes. One particular area of focus is implementation science to address variation in practice.

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“…Blood products have been acknowledged as a critical recourse in healthcare and, accordingly, the WHO has recommended strategies to ensure blood product supply meets the demand, clinical guidelines on the appropriate use of blood products, and strategies to reduce transfusion rates [2]. Although the implementation of patient blood management (PBM) programs utilizing multiple strategies have significantly reduced transfusion rates, pre-operative anemia has a high prevalence in surgical patients and blood products are still required for dedicated procedures, associated with a likely transfusion risk [3,4]. Furthermore, transfusion thresholds remain to be determined and are being investigated for individual patients and specific procedures [5,6].…”

Section: Introductionmentioning

confidence: 99%

A Novel Scoring System Predicting Red Blood Cell Transfusion Requirements in Patients Undergoing Invasive Spine Surgery

Schenk,

Ende,

Hoch

et al. 2024

JCM

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Background: Access to blood products is crucial for patient safety during the perioperative course. However, reduced donations and seasonally occurring blood shortages pose a significant challenge to the healthcare system, with surgeries being postponed. The German Blood Transfusion act requires that RBC packages become assigned to an individual patient, resulting in a significant reduction in the available blood products, further aggravating shortages. We aimed to develop a scoring system predicting transfusion probability in patients undergoing spine surgery to reduce assignment and, thus, increase the availability of blood products. Methods: The medical records of 252 patients who underwent spine surgery were evaluated and 18 potential predictors for RBC transfusion were tested to construct a logistic-regression-based predictive scoring system for blood transfusion in patients undergoing spine surgery. Results: The variables found to be the most important included the type of surgery, vertebral body replacement, number of stages, and pre-operative Hb concentration, indicating that surgical specification and the extent of the surgical procedure were more influential than the pre-existing patient condition and medication. Conclusions: Our model showed a good discrimination ability with an average AUC [min, max] of 0.87 [0.6, 0.97] and internal validation with a similar AUC of 0.84 [0.66, 0.97]. In summary, we developed a scoring system to forecast patients’ perioperative transfusion needs when undergoing spine surgery using pre-operative predictors, potentially reducing the need for RBC allocation and, thus, resulting in an increased availability of this valuable resource.

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German Patient Blood Management Network: effectiveness and safety analysis in 1.2 million patients

Cited by 15 publications

References 23 publications

Preoperative hemoglobin thresholds for survival equity in women and men

Preoperative hemoglobin thresholds for survival equity in women and men

Harnessing the potential of data‐driven strategies to optimise transfusion practice

A Novel Scoring System Predicting Red Blood Cell Transfusion Requirements in Patients Undergoing Invasive Spine Surgery

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