Division of Infectious Diseases, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, Korea.
J Korean Med Sci. 2023 Feb 27;38(8):e64. doi: 10.3346/jkms.2023.38.e64.
Elderly patients with hip fractures frequently receive perioperative transfusions, which are associated with increased morbidity and mortality. This study aimed to evaluate the impact of a patient blood management (PBM) program on the appropriateness of red blood cell (RBC) transfusion and clinical outcomes in geriatric patients undergoing hip fracture surgery.
In 2018, the revised PBM program was implemented at the Korea University Anam Hospital, Seoul, Republic of Korea. Elderly patients aged ≥ 65 years who underwent hip fracture surgery from 2017 to 2020 were evaluated. Clinical characteristics and outcomes were analyzed according to the timing of PBM implementation (pre-PBM, early-PBM, and late-PBM). Multiveriate regression analysis was used to evaluate the risk factors of the adverse outcomes, such as in-hospital mortality or 30-day readmission.
A total of 884 elderly patients were included in this study. The proportion of patients who received perioperative RBC transfusions decreased significantly (43.5%, 40.1%, and 33.2% for pre-PBM, early-PBM, and late-PBM, respectively; = 0.013). However, the appropriateness of RBC transfusion significantly increased (54.0%, 60.1%, and 94.7%, respectively; < 0.001). The duration of in-hospital stay and 30-day readmission rates significantly decreased. Multivariable regression analysis revealed that RBC transfusion (odds ratio, 1.815; 95% confidence interval, 1.137-2.899; = 0.013) was significantly associated with adverse outcomes.
Implementing the PBM program increased the appropriateness of RBC transfusion without compromising transfusion quality and clinical outcomes. Therefore, adopting the PBM program may improve the clinical management of elderly patients following hip fracture surgery.
髋部骨折的老年患者经常接受围手术期输血，这与发病率和死亡率的增加有关。本研究旨在评估患者血液管理（PBM）计划对接受髋部骨折手术的老年患者的红细胞（RBC）输血和临床结局的适当性的影响。
2018 年，韩国大学安山医院（韩国首尔）实施了修订后的 PBM 计划。评估了 2017 年至 2020 年期间接受髋部骨折手术的年龄≥65 岁的老年患者。根据 PBM 实施时间（预 PBM、早期 PBM 和晚期 PBM）分析临床特征和结局。多变量回归分析用于评估不良结局（如住院内死亡率或 30 天再入院）的风险因素。
本研究共纳入 884 名老年患者。接受围手术期 RBC 输血的患者比例显著下降（预 PBM、早期 PBM 和晚期 PBM 分别为 43.5%、40.1%和 33.2%；=0.013）。然而，RBC 输血的适当性显著增加（分别为 54.0%、60.1%和 94.7%；<0.001）。住院时间和 30 天再入院率显著降低。多变量回归分析显示，输血（比值比，1.815；95%置信区间，1.137-2.899；=0.013）与不良结局显著相关。
实施 PBM 计划提高了 RBC 输血的适当性，同时不影响输血质量和临床结局。因此，采用 PBM 计划可能会改善髋部骨折手术后老年患者的临床管理。
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