Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
Division of Colon and Rectal Surgery, Department of Surgery, Daegu Catholic University Hospital, School of Medicine Catholic University of Daegu, Daegu, Republic of Korea.
Blood Transfus. 2022 Nov;20(6):475-482. doi: 10.2450/2022.0328-21. Epub 2022 Jun 14.
Patients undergoing colorectal cancer surgery may require a blood transfusion. However, blood transfusions are associated with postoperative complications and long-term oncologic outcomes. Patient blood management (PBM) is an evidence-based multimodal approach for blood transfusion optimisation. We sought to investigate the effects of PBM implementation in blood transfusion practice and on short-term postoperative outcomes.
This study retrospectively reviewed data from 2,080 patients who had undergone colorectal cancer surgery at a single centre from 2015 to 2020. PBM was implemented in 2018, and outcomes were compared between the pre-PBM (2015-2017) and the post-PBM (2018-2020) periods.
A total of 951 patients in the pre-PBM group and 1,129 in the post-PBM group were included. The transfusion rate of the total number of packed red blood cells (PRBCs) used decreased after PBM implementation (16.3 vs 8.3%; p<0.001). The rate of appropriately transfused PRBCs increased from the pre-PBM period to the post-PBM period (42 vs 67%; p<0.001). There was no significant difference in rates of complications between the two groups (23.0 vs 21.5%; p=0.412); however, a reduction in both anastomosis leakage (5.8 vs 3.7%; p=0.026) and the length of stay after surgery (LOS) (10.3±11.2 vs 8.2±5.7 days; p<0.001) was reported after PBM implementation.
The PBM programme optimised the transfusion rate in patients undergoing colorectal cancer surgery. Implementation of the PBM programme had a positive effect on postoperative length of stay and anastomosis leakage while no increase in the risk of other complications was reported.
接受结直肠癌手术的患者可能需要输血。然而，输血与术后并发症和长期肿瘤学结果有关。患者血液管理（PBM）是一种优化输血的基于证据的多模式方法。我们旨在研究 PBM 在输血实践中的实施及其对短期术后结果的影响。
本研究回顾性分析了 2015 年至 2020 年在一家中心接受结直肠癌手术的 2080 例患者的数据。2018 年实施了 PBM，比较了 PBM 前（2015-2017 年）和 PBM 后（2018-2020 年）两个时期的结果。
在 PBM 前组中共有 951 例患者，在 PBM 后组中有 1129 例患者。PBM 实施后，总使用的浓缩红细胞（PRBC）的输血率降低（16.3%比 8.3%；p<0.001）。从 PBM 前到 PBM 后，适当输血的 PRBC 率增加（42%比 67%；p<0.001）。两组之间的并发症发生率没有显著差异（23.0%比 21.5%；p=0.412）；然而，PBM 实施后报告的吻合口漏（5.8%比 3.7%；p=0.026）和术后住院时间（LOS）（10.3±11.2 比 8.2±5.7 天；p<0.001）均有所减少。
PBM 计划优化了接受结直肠癌手术患者的输血率。实施 PBM 计划对术后 LOS 和吻合口漏有积极影响，同时未报告其他并发症风险增加。
