Who Needs Most? Multicenter Subanalysis of Blood Transfusion Profiles in the German Patient Blood Management Network Registry

TL;DR

This study identifies three blood transfusion profiles in surgical patients and shows that targeted blood management can improve outcomes for those needing the most transfusions.

Contribution

The study introduces distinct transfusion profiles and demonstrates the effectiveness of Patient Blood Management in high-risk surgical patients.

Findings

Most patients (92%) required minimal blood components, while a small high-risk group needed significantly more.

High transfusion profile patients saw a 2.2% reduction in adverse outcomes with Patient Blood Management interventions.

Low transfusion profile patients offer opportunities for better resource allocation and risk stratification.

Abstract

Background: Blood transfusion practices have evolved significantly in order to enhance patient care. The optimal strategies for administering red blood cell (RBC) transfusions is becoming rather clear; however, a comprehensive understanding of patients requiring transfusions of other blood components remains inadequate, leading to variability in clinical practice and outcomes. Here we examine surgical patients that could benefit from perioperative risk stratification. Study Design and Methods: We analyzed subgroups of a prospective, multicenter follow-up study and identified three distinct transfusion profiles across surgical disciplines: low (n = 1,035,588, 92.0%), moderate (n = 81,243, 7.2%), and high (n = 8413, 0.7%). These profiles are characterized by varying requirements for RBC, plasma, and platelet units. Results: While most patients were clustered in the low transfusion profile, blood component use only increased significantly in the high transfusion profile. Notably, patients in the high transfusion profile benefited from Patient Blood Management (PBM) interventions with a reduction of the predefined composite endpoint of in-hospital mortality and postoperative complications (ischemic stroke, myocardial infarction, pneumonia, sepsis and acute renal failure with renal replacement therapy) from 28.2% to 26.0% and an OR of 0.90 (95% CI 0.80–1.00, p = 0.048) compared to the moderate transfusion profile. Conversely, the low transfusion profile encompassed patients with minimal transfusion needs, presenting opportunities to refine resource allocation and risk stratification. Discussion: These findings underscore the potential for improving patient outcomes and indicate that implementing targeted PBM interventions can reduce the risk of adverse events and mortality. This study advances the field by identifying specific transfusion profiles that can guide future research and clinical practices towards more personalized and efficient blood management in perioperative care.

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