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Master Thesis

Patient blood management pour les arthrodèses programmées de deux étages et plus : évaluation rétrospective des pratiques dans le service de neurochirurgie du CHU de Nice

Abstract : Background: Patient Blood Management (PBM) is a patient-centered therapeutic approach, seeking to improve the taking care of those who may be at risk of transfusion during a scheduled surgery. The aim of our study is to analyze the PBM practices regarding the spinal fusion surgery of two or more levels, in order to emphasize areas of development.
Materials and Methods: Adult patients, going through a scheduled spinal fusion surgery of two or more levels, in the neurosurgery service of the CHU of Nice, from January 1st 2017 to October 31st 2019, were included in our single-center retrospective observational study. The Key Performance Indicators focused on the detection and treatment of preoperative anemia and iron deficiency, per and post-operative practices (tranexamic acid, intravenous iron), the peri-operative transfusion rate, the hospital length of stay and the morbimortality at 30 days.
Results: We included 124 patients, including 22 for a scoliosis. 23 (18,5%) were anemic at the anesthesia consultation. Eight (34,8%) of these patients had an evaluation of their iron status and six (26,1%) were treated almost exclusively with oral iron, without any significant improvement of their hemoglobin after treatment (11,66 g/dl vs. 11,86 g/dl (p = 0,5596)). Tranexamic acid was used for 47 (37,9%) patients. The peri-operative transfusion rate was 22,5%, or 28 patients transfused for 40 transfusions. 57 (46%) patients had post-operative intravenous iron. The average length of stay was 7,65 days, and it was significantly longer for anemic patients and transfused patients than those without anemia and those without transfusion (8,83 days vs. 7,38 days ; 9,68 days vs. 7,05 days (p < 0,0001)).
Conclusion: Our work highlighted a certain delay in the implementation of PBM measures for patients going through a scheduled spinal fusion surgery of two or more levels. This has encouraged us to put a PBM protocol in practice. Its impact on the service practices, transfusion rate and the patient outcomes, will have to be assessed within a year.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03116342
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Submitted on : Wednesday, January 20, 2021 - 11:40:52 AM
Last modification on : Tuesday, November 23, 2021 - 3:15:45 PM

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Carlo Bertolotto. Patient blood management pour les arthrodèses programmées de deux étages et plus : évaluation rétrospective des pratiques dans le service de neurochirurgie du CHU de Nice. Médecine humaine et pathologie. 2020. ⟨dumas-03116342⟩

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