Objectives:

To determine whether a multidisciplinary, multimodal Patient Blood Management (PBM) program for patients undergoing surgery is effective in reducing perioperative complication rate, and thereby is effective in improving clinical outcome.

Background:

PBM is a medical concept with the focus on a comprehensive anemia management, to minimize iatrogenic (unnecessary) blood loss, and to harness and optimize patient-specific physiological tolerance of anemia.

Methods:

A systematic review and meta-analysis was performed. Eligible studies had to address each of the 3 PBM pillars with at least 1 measure per pillar, for example, preoperative anemia management plus cell salvage plus rational transfusion strategy. The study protocol has been registered with PROSPERO (CRD42017079217).

Results:

Seventeen studies comprising 235,779 surgical patients were included in this meta-analysis (100,886 pre-PBM group and 134,893 PBM group). Implementation of PBM significantly reduced transfusion rates by 39%[risk ratio (RR) 0.61, 95% confidence interval (CI) 0.55–0.68, P< 0.00001], 0.43 red blood cell units per patient (mean difference− 0.43, 95% CI− 0.54 to− 0.31, P< 0.00001), hospital length of stay (mean difference− 0.45, 95% CI− 0.65 to− 0.25, P< 0, 00001), total number of complications (RR 0.80, 95% CI 0.74–0.88, P< 0.00001), and mortality rate (RR 0.89, 95% CI 0.80–0.98, P= 0.02).

Conclusions:

Overall, a comprehensive PBM program addressing all 3 PBM pillars is associated with reduced transfusion need of red blood cell units, lower complication and mortality rate, and thereby improving clinical outcome. Thus, this first meta-analysis investigating a multimodal approach should motivate all executives and health care providers to support further PBM activities.