Rethinking Transfusion Strategies — Better Surgical Outcomes With Blood-Conserving Care

Background: Major noncardiac surgery is frequently complicated by anemia, bleeding, and coagulopathy, all of which contribute to postoperative morbidity and mortality. Although blood transfusion has traditionally been used to address these issues, growing evidence suggests that transfusion itself may carry independent risks. This has led to increased interest in strategies that reduce or avoid transfusion, including transfusion-free blood management and patient blood management (PBM) approaches. Objective: (1) To compare outcomes between nontransfusable patients receiving transfusion-free blood management and transfusable patients undergoing major surgery. (2) To evaluate outcomes among transfusable patients treated with PBM versus those receiving standard care without such protocols. Design: Retrospective cohort study. Methods: 25,979 adult patients undergoing major noncardiac surgery at 2 hospitals within the same German health care network between 2008 and 2020. Study participants more...