Readmission rates for surgeons WILL become a quality indicator of performance. Quality parameters among Home Health agencies are nonexistent, but will reflect on surgeon’s performance. Greater awareness regarding predictors of readmission rates is necessary to demonstrate improved surgical quality.

Background Management of anemia in surgical oncology patients remains one of the key quality components in overall care and cost. Continued reports demonstrate the effects of hospital transfusion, which has been demonstrated to lead to a longer length of stay, more complications, and possibly worse overall oncologic outcomes. The hypothesis for this study was that a dedicated restrictive transfusion protocol in patients undergoing hepatectomy would lead to less overall blood transfusion with no increase in overall morbidity. Methods A cohort study was performed using our prospective database from 1/2000 to 6/2013. September of 2011 served as the separation point for the date of operation criteria because this marked the implementation of more restrictive blood transfusion guidelines. Results a total of 186 patients undergoing liver resection were reviewed. The restrictive blood transfusion guidelines reduced the percentage of patients that received blood from 31.0% before 09/01/2011 to 23.3% after this date (p=0.03). The liver procedure that was most consistently associated with higher levels of transfusion was a right lobectomy (16%). Prior surgery and endoscopic stent were the two preoperative interventions associated with receiving blood. Patients who received blood before and after the restrictive period had similar predictive factors: Major hepatectomies, higher intra-operative blood loss, lower pre-operative hemoglobin, older age, prior systemic chemotherapy, and lower pre-operative nutritional parameters (all P<0.05). Patients who received blood did not have worse overall progression free survival or overall survival. Conclusion A restrictive blood transfusion protocol reduces the incidence of blood transfusions and the number of packed red blood cells transfused. Patients who require blood have similar pre-operative and intra-operative factors that cannot be mitigated in oncology patients. Restrictive use of blood transfusions can reduce cost and does adversely effects patients undergoing liver resection.

Background The purpose of this study was to determine the impact of a restrictive blood transfusion protocol on the number of transfusions performed and the related effect on patient morbidity. Methods A cohort study was performed using our prospective database with information from 01/01/2000–06/01/2013. The restrictive blood transfusion protocol was implemented in 9/2011, so this date served as the separation point for the date of operation criteria. Results For the study, 415 patients undergoing operation for an abdominal malignancy were reviewed. Following the restrictive blood transfusion protocol the percentage of patients that received blood dropped from 35.6% to 28.3%. The percentage of patients that experienced perioperative complication was significantly higher in transfused patients compared to those that did not receive blood(p=0.0001). There was no statistical significance observed between the four groups for the length of stay at the hospital following their procedure. Conclusion The restrictive blood transfusion protocol resulted in a reduction of the percentage of patients transfused, and there was no evidence to suggest that it negatively impacted the outcomes of patients in this group.

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