The imperative integration of patient blood management into ERACS: bridging the gap for optimizing outcomes in cardiac surgery.

backgroundEnhanced Recovery After Surgery (ERAS) in cardiac surgery was designed to improve outcomes, reduce complications, and optimize recovery. Despite these efforts, perioperative anemia, a key modifiable risk factor that affects 20 to 41% of patients, remains under-addressed and is strongly associated with increased transfusion rates, morbidity, and mortality. Patient Blood Management (PBM) has demonstrated efficacy in improving outcomes by optimizing hemoglobin levels, reducing blood loss, and minimizing transfusions, although it is not yet fully integrated into cardiac ERAS pathways. MAIN TEXT: ERAS pathways are patient-centered, multidisciplinary, preventive and evidence-based. Although the principles of PBM align with ERAS, detailed PBM targets are often neglected in ERAS-based line of care. In cardiac surgery, the risks associated with anemia and transfusion are substantially higher than in other surgical specialties. However, perioperative interventions might manage anemia, mitigate bleeding risks, and improve tolerance to anemia in this particularly sensitive population. Implementation challenges include the need for institutional culture shifts and multidisciplinary education maintaining clinical awareness to support individualized recovery trajectories.

conclusionIntegrating PBM into cardiac ERAS-based pathways addresses a critical gap that could lead to improved patient outcomes, reduced complications, lower transfusion rates, and optimized resource utilization. While healthcare progressively focuses on safety, quality, and value-based care, the convergence of ERAS and PBM offers a comprehensive approach to advancing perioperative medicine in cardiac surgery.