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PLASTIC RECONSTRUCTIVE AND REGENERATIVE SURGERY

Original article

Ahead-of-Print

Efficiency in packed red blood management for brain tumor resection: multicenter prospective cohort study (TScoreBTR)

Authors

Laura Contreras-Lopez , Fernando Iturri Clavero , Paola Andrea Hurtado Restrepo , Natalia Pérez de Arriba , Agustín Díaz Álvarez , José Alberto Montes Armenteros , Marcos Polo Pellicena , Ana Fernández Colorado , Paloma Doménech Asensi , Juan Fernández Candil , Laura Gutiérrez García , Paula Solis Albamonte , Oliva Romero Kräuchi , Jorge M. Nuñez-Cordoba , Antonio Martinez-Simon

Key words: efficiency, red blood cells, crossmatch, blood transfusion, brain tumour resection
DOI: 10.2450/BloodTransfus.1069
Patient Blood Management
Publication Date: 2025-08-28

Abstract

Background - There are no optimised patient blood management (PBM) protocols for brain tumor resection (BTR). The aim of this study was to compare the prevalence of packed red cells (PRCs) units reserved with the prevalence of transfusion during BTR and analyse preoperative anemia.

Materials and methods - Prospective observational multicentre study for adult patients who underwent elective BTR. Fourteen tertiary-level hospitals participated from March 2021 to February 2024. The primary outcomes were the prevalence of PRCs reserved and transfused, and the efficiency metrics: crossmatch to transfusion ratio (C/T ratio), transfusion probability (TP), and transfusion index (TI). The secondary outcome was the prevalence of preoperative anemia. ClinicalTrials.gov (NCT05832450).

Results - We analysed data from 1,384 patients. A percentage of 83.3% of them had PRCs units reserved, with a median (range) of 2 (1 to 8) units per patient. The prevalence of intraoperative transfusion was 6.6% (95% CI: 5.4 to 8.0%). There was a significantly inefficient processes with a high C/T ratio (14.85), low TP (7.9%), and low TI (0.14). The percentage of women requiring at least one PRCs transfusion was more than double that of men (9.3 vs 3.7%, p<0.001). The prevalence of preoperative anemia was 25.4% with a statistically significant difference in anemia seen between women and men (36.6 vs 13.6%, p<0.001). When adjusting for preoperative hemoglobin and presumptive diagnosis, the difference between women and men was not significant (OR 1.58 [95% CI: 0.94 to 2.63], p=0.083).

Discussion - Systematic PRCs unit reservation remains a common practice despite the low prevalence of transfusions for BTR in Spain. A high prevalence of preoperative anemia was found, particularly among women. We need objective criteria for PBM to allow optimal crossmatching and PRCs reservation for BTR and to subsequently reduce inefficiencies in perioperative PRCs management.

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Authors

Laura Contreras-Lopez - Department of Anesthesia, Critical Care and Pain Clinic-Hospital Universitari de Bellvitge-Barcelona-HUB. Health Group, Neuroscience Program, Perioperative Physiopathology and Pain, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, UB, Barcelona, Spain

Fernando Iturri Clavero - Department of Anesthesia, Critical Care and Pain Clinic, Hospital Universitario de Cruces, Bilbao, Spain https://orcid.org/0000-0002-5410-0627

Paola Andrea Hurtado Restrepo - Department of Anesthesia, Critical Care and Pain Clinic, Hospital Clinic Barcelona, Barcelona, Spain https://orcid.org/0000-0002-4875-2901

Natalia Pérez de Arriba - Department of Anesthesia, Critical Care and Pain Clinic,Hospital Universitario Central de Asturias, Oviedo, Spain https://orcid.org/0000-0003-0363-6314

Agustín Díaz Álvarez - Department of Anesthesia, Critical Care and Pain Clinic, Hospital Universitario de Salamanca, Salamanca, Spain https://orcid.org/0000-0002-6229-8311

José Alberto Montes Armenteros - Department of Anesthesia, Critical Care and Pain Clinic, Complejo Asistencial Universitario de León, Leon, Spain

Marcos Polo Pellicena - Department of Anesthesia, Critical Care and Pain Clinic, Hospital Universitario Miguel Servet, Zaragoza, Spain

Ana Fernández Colorado - Department of Anesthesia, Critical Care and Pain Clinic, Hospital Universitario Parc Taulí de Sabadell, Sabadell, Spain https://orcid.org/0000-0002-1371-7348

Paloma Doménech Asensi - Department of Anesthesia, Critical Care and Pain Clinic, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain https://orcid.org/0000-0002-9980-7140

Juan Fernández Candil - Department of Anesthesia, Critical Care and Pain Clinic, Hospital del Mar, Barcelona, Spain https://orcid.org/0000-0002-5723-5463

Laura Gutiérrez García - Department of Anesthesia, Critical Care and Pain Clinic, Hospital Universitario Marqués de Valdecilla, Santander, Spain https://orcid.org/0009-0003-7137-3584

Paula Solis Albamonte - Department of Anesthesia, Critical Care and Pain Clinic, Hospital General Universitario de Valencia, Valencia, Spain https://orcid.org/0000-0002-5324-7459

Oliva Romero Kräuchi - Department of Anesthesia, Critical Care and Pain Clinic, Hospital Universitario Son Espases, Mallorca, Spain https://orcid.org/0009-0000-0074-0760

Jorge M. Nuñez-Cordoba - Research Support Service, Central Clinical Trials Unit, Clínica Universidad de Navarra, Pamplona, Spain https://orcid.org/0000-0003-0550-1069

Antonio Martinez-Simon - Department of Anesthesia, Critical Care and Pain Clinic, Clínica Universidad de Navarra, Pamplona, Spain https://orcid.org/0000-0002-3039-4798

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