Authors: Lucas M, et al.
Anesthesia & Analgesia. August 29, 2025. doi:10.1213/ANE.0000000000007718
This large retrospective cohort study evaluated outcomes of 25,979 adult noncardiac surgical patients at two German hospitals between 2008 and 2020. Patients received one of three models of care: transfusion-free blood management (nontransfusable patients), patient blood management (PBM), or no PBM.
Patients in the transfusion-free group had significantly lower mortality, renal and respiratory complications, readmissions, and shorter hospital stays compared with transfusable patients. Importantly, no acute myocardial infarction occurred in the transfusion-free group. Among transfusable patients, those managed with PBM had improved mortality, surgical site complication rates, renal and respiratory outcomes, and reduced hospital length of stay compared with patients without PBM. PBM was also associated with lower transfusion rates and blood loss, though it showed a slightly higher readmission rate.
What You Should Know
• Transfusion-free blood management in nontransfusable patients was associated with superior outcomes compared to transfusable patients.
• Among transfusable patients, PBM strategies improved survival, reduced complications, and lowered transfusion use.
• Readmissions were higher in PBM patients, suggesting closer follow-up may be necessary.
• The findings reinforce the value of minimizing or avoiding transfusion when possible.
Practice Implication
Integrating PBM principles into surgical care can reduce complications, transfusion needs, and length of stay. For centers treating nontransfusable patients, structured transfusion-free strategies can yield outcomes as good as or better than transfusion-permissive care. Hospitals should consider systematic PBM adoption, while monitoring and addressing potential drivers of higher readmission.
References
Lucas M, et al. Anesth Analg. 2025. doi:10.1213/ANE.0000000000007718
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