Patient Blood Management Adoption and Transfusion-Threshold Concordance Among Romanian Anesthesiologists: National Survey Analysis

Abstract Background Romania issued national patient blood management (PBM) guidelines in 2018. A 2023 national survey described the overall uptake of PBM among anesthesiologists but did not examine which clinicians and institutions adopted PBM, nor whether stated transfusion thresholds aligned with a study-defined restrictive reference. Objective This study aimed to identify determinants of PBM adoption and to quantify transfusion-trigger concordance, using a planned, exploratory, cross-sectional secondary analysis of the 2023 survey. Methods We analyzed 511 responses to the 38-item Romanian Society of Anaesthesia and Intensive Care (SRATI) PBM survey. Three adoption outcomes (applying PBM, a formal hospital PBM group, and routine preoperative anemia treatment) were modeled by multivariable logistic regression against physician grade, hospital category, and local PBM educational events. Eight standardized clinical vignettes (age×cardiac disease×bleeding state) were scored against a restrictive hemoglobin reference (7 g/dL general; 8 g/dL with cardiac disease). The reported timing of the preanesthetic consultation (4 frequency items) was additionally examined as a determinant of preoperative anemia 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) reported a formal PBM group, and 33.5% (117/349) reported routine preoperative anemia treatment. Local PBM educational events were the strongest adjusted correlate of reported adoption (applying PBM: adjusted odds ratio [aOR] 9.78, 95% CI 4.33‐22.07; P <.001; formal group: aOR 7.72, 95% CI 4.30‐13.88; P <.001). Earlier preanesthetic consultation was associated with routine preoperative anemia treatment (aOR 1.79 per frequency level for consultation more than 7 days before surgery, 95% CI 1.36‐2.35; P <.001). Transfusion-trigger concordance was lower for older than younger patients in otherwise identical scenarios (eg, active bleeding without cardiac disease: 195/345, 56.5% at ≥65 years vs 288/347, 83% at <65 years), and 56.5% (196/347) endorsed a liberal trigger (hemoglobin ≥8 g/dL) in at least one noncardiac scenario. Self-reported PBM application was not associated with a restrictive transfusion pattern (aOR 1.17, 95% CI 0.69‐1.98; P =.56). Findings were unchanged across scoring rules, and reported PBM application was similar among respondents who did and did not complete the demographic block (246/329, 74.8% vs 127/177, 71.8%; P =.53). Conclusions In this exploratory cross-sectional analysis, reported PBM adoption was associated more strongly with local educational activity than with hospital category or physician seniority. Self-reported PBM application was not associated with restrictive stated thresholds in hypothetical scenarios, and respondents selected more liberal thresholds for older patients. Standardized multidisciplinary pathways, earlier anemia screening shared with the surgical team, and education focused on transfusion decisions may help address these gaps. Prospective studies using observed process measures, transfusion practice, and clinical outcomes are needed.