Perioperative Integration of Patient Blood Management into Anesthetic Pathways: A Systematic Review of Multidimensional Strategies for Transfusion Stewardship and Outcome Enhancement

Background: Perioperative bleeding and allogeneic blood transfusion (ABT) are associated with increased patient morbidity, mortality, and healthcare costs. Patient Blood Management (PBM) employs multidisciplinary, evidence-based strategies to optimize outcomes by preserving a patient’s own blood. Despite PBM’s recognized efficacy, a comprehensive synthesis of its multidimensional integration into anesthetic pathways and its impact on transfusion stewardship and patient outcomes remains limited. Objective: This systematic review aims to synthesize and critically evaluate multidimensional PBM strategies integrated into anesthetic pathways, assessing their effects on transfusion stewardship and patient outcomes. Methods: Prospectively registered with PROSPERO (CRD1113176) and adhering to PRISMA 2020 guidelines, we searched PubMed, Embase, Cochrane CENTRAL, Web of Science, and Scopus from January 1, 2005, to July 26, 2025. Two independent reviewers screened citations, including 45 full-text articles. Data extraction and risk of bias assessment (using RoB 2 and ROBINS-I) were conducted independently. Findings were synthesized narratively, with meta-analysis performed when heterogeneity permitted. Results: Across 45 studies, multidimensional PBM strategies within anesthetic pathways significantly reduced ABT rates and total units transfused, enhancing transfusion stewardship. These strategies also lowered postoperative complications (e.g., surgical site infections, acute kidney injury) and hospital stay duration. Observational studies reported reduced long-term mortality, though randomized controlled trials showed inconsistent short-term mortality benefits. Non-randomized studies exhibited higher risk of bias. Conclusion: Multidimensional PBM strategies, effectively integrated into anesthetic pathways, significantly improve transfusion stewardship and patient outcomes. Anesthesiologists are pivotal in leading these approaches, reinforcing PBM as a global standard of care to enhance patient safety and optimize resource utilization.