Effect of patient blood management program on outcomes of the elderly with femur fracture who underwent orthopedic surgery

초록

Background: This study aimed to investigate the impact of the patient blood management (PBM) program on outcomes of the elderly with femur fracture who underwent orthopedic surgery. Methods: In 2018, the revised PBM program was implemented at the Korea University Anam Hospital, Seoul, Republic of Korea. A longitudinal evaluation of the elderly patients ≥ 65 years with femur fractures who underwent orthopedic surgery from 2017 to 2020 was performed. Clinical characteristics and outcomes were analyzed according to the timing of the PBM implementation (pre-PBM, January 2017 – December 2017, early-PBM, January 2018 –June 2019, late-PBM, July 2019 – December 2020). Multivariable regression analysis was used to assess risk factors of the adverse outcomes defined as in-hospital mortality or 30-day readmission. Results: A total of 884 patients [Pre-PBM 200 (22.6%), early-PBM 344 (38.9%), and late-PBM 340 (38.5%)] were included in the study with median age of 80 years. The proportion of the patients who received perioperative red blood cell (RBC) transfusion decreased significantly: 43.5%, 40.1%, and 33.2% for periods of Pre-PBM, early-PBM, and latePBM, respectively (P=0.013). However, appropriateness of RBC transfusion significantly increased (54.0%, 60.1%, and 94.7%, P < 0.001). Although there was no significant difference in terms of in-hospital mortality (0.5%, 2.6%, and 2.1%, P=0.340), the rate of 30-day readmission was significantly decreased (12.0%, 7.6%, and 6.8%, P=0.045). Multivariable regression analysis revealed that RBC transfusion (odds ratio [OR] 1.815, 95% confidence interval [CI] 1.137 – 2.899, P=0.013) was significantly associated with the adverse outcomes while implementation of PBM showed significant inverse association (OR 0.557, 95% CI 0.329 – 0.944, P=0.030). Conclusion: Implementation of PBM program reduced the use of RBC transfusion without compromising the quality of transfusion and clinical outcomes. Thus, adoption of PBM program may contribute to improvement of clinical management in the elderly patients with femur fractures who underwent orthopedic surgery.