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Transfus Apher Sci. 2018 Aug;57(4):517-523. doi: 10.1016/j.transci.2018.05.029. Epub 2018 May 30.

Impact of a patient blood management program within an Orthogeriatric care service.

Author information

1
Department of Geriatric Medicine, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain; Clinical Department, School of Health Sciences, Universidad Europea, Madrid, Spain. Electronic address: rafael.bielza@salud.madrid.org.
2
Department of Hematology, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain; Clinical Department, School of Health Sciences, Universidad Europea, Madrid, Spain.
3
Department of Oncology, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain; Clinical Department, School of Health Sciences, Universidad Europea, Madrid, Spain.
4
Department of Orthopedics, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain; Clinical Department, School of Health Sciences, Universidad Europea, Madrid, Spain.
5
School of Doctoral Studies & Research, Universidad Europea, Madrid, Spain.
6
Department of Geriatric Medicine, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain; Clinical Department, School of Health Sciences, Universidad Europea, Madrid, Spain.
7
Department of Internal Medicine, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain; Clinical Department, School of Health Sciences, Universidad Europea, Madrid, Spain.

Abstract

BACKGROUND:

Patient blood management (PBM) performs multidisciplinary strategies to optimize red blood cell (RBC) transfusion. Orthogeriatric share care models (surgeon and geriatrician manage the patient together from admission) have the goal of improving outcomes in hip fracture patients.

MATERIAL AND METHODS:

A prospective observational study was conducted. Patients aged ≥70 years undergoing hip fracture (HF) surgery were consecutively included. When admitted on the orthogeriatric service a PBM protocol was applied based on: perioperative antithrombotic management, intravenous iron sucrose administration and restrictive transfusion criteria. Risk factors, clinical and functional effects of transfusion and its requirements were assessed to audit our model.

RESULTS:

A total of 383 patients participated (women, 78.8%; median age, 86 (82-90) years). 210 patients (54.8%) were transfused. Age (OR = 1.055, 95% CI 1.017-1.094; p = 0.004) and Hemoglobin (Hb) level on admission (OR = 0.497, 95% CI 0.413-0.597; p < 0.001) were found to be significant risk factors for transfusion. Transfusion increased length of stay (b = 1.37, 95% CI 0.543-2.196; p = 0.001) but did not have an effect on other variables.

DISCUSSION:

The PBM program established within an orthogeriatric service showed positive outcomes in terms of clinical complications, mortality, delirium or functional recovery in transfused patients, whereas it did not impact on shorter length of stay. The risk of transfusion on admission was predicted with the lower Hb levels on admission, along with the age of the patients. New measurements as homogenous restrictive transfusion criteria, a single-unit RBC transfusion and the assessment of the intravenous iron efficacy are need to be applied as a result of the high transfusion requirements.

KEYWORDS:

Hip fracture; Orthogeriatric service; Patient blood management; Red blood cell transfusión

PMID:
29871842
DOI:
10.1016/j.transci.2018.05.029
[Indexed for MEDLINE]

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