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

BACKGROUND: There are no optimized 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 were 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.