JMIR Publications

ABSTRACT

Background:

Romania issued national Patient Blood Management (PBM) guidelines in 2018. A 2023 national survey described the overall uptake of PBM among anaesthesiologists but did not examine which clinicians and institutions adopt PBM, nor whether stated transfusion thresholds align with a restrictive, guideline-concordant strategy.

Objective:

To identify determinants of PBM adoption and to quantify transfusion-trigger concordance, using a planned, exploratory secondary analysis of the 2023 survey.

Methods:

We analysed 511 responses to the 37-item Romanian Society of Anaesthesia and Intensive Care (SRATI) PBM survey. Three adoption outcomes (applying PBM, a formal hospital PBM group, and routine preoperative anaemia treatment) were modelled by multivariable logistic regression against physician grade, hospital category, and local PBM educational events. Eight standardised clinical vignettes (age × cardiac disease × bleeding state) were scored against a restrictive haemoglobin (Hb) reference (7 g/dL general; 8 g/dL with cardiac disease). The reported timing of the pre-anaesthetic consultation (four frequency items) was additionally examined as a determinant of preoperative anaemia treatment. This was a planned, exploratory secondary analysis; the robustness of the main findings was examined in sensitivity analyses that accounted for survey attrition and for alternative transfusion-threshold scoring rules.

Results:

Overall, 73.7% (373/506) reported applying PBM, 33.1% (158/477) a formal PBM group, and 33.5% (117/349) routine preoperative anaemia treatment. Organising local PBM educational events was the dominant independent predictor of adoption (applying PBM: adjusted odds ratio [aOR] 9.78, 95% CI 4.33–22.07; formal group: aOR 7.72, 95% CI 4.30–13.88), whereas hospital category was largely non-significant after adjustment. Earlier pre-anaesthetic consultation independently predicted routine preoperative anaemia treatment (adjusted OR 1.79 per frequency level for consulting more than seven days before surgery, 95% CI 1.36–2.35). Transfusion-trigger concordance was markedly lower for older than younger patients in otherwise identical scenarios (e.g. bleeding non-cardiac patient: 56.5% at ≥65 years vs 83.0% at <65 years), and 56.5% (196/347) endorsed a liberal trigger (Hb ≥8 g/dL) in at least one non-cardiac scenario. Self-reported application of PBM did not predict a restrictive transfusion pattern (aOR 1.17, 95% CI 0.69–1.98; P=0.56). Conclusions were unchanged across scoring rules and were not affected by attrition (applying PBM 74.8% vs 71.8% in demographic-block completers vs non-completers; P=0.5285).

Conclusions:

PBM adoption in Romania is driven more by local educational activity than by hospital size or seniority, yet structural adoption does not translate into restrictive transfusion behaviour at the bedside, and older patients receive systematically more liberal triggers. Educational interventions and behaviour-focused implementation—particularly for elderly patients—are priorities for narrowing the gap between endorsing PBM and practising it; earlier pre-anaesthetic assessment offers a further, organisational lever for preoperative anaemia care.