Blood transfusion and cancer surgery outcomes: A continued reason for concern

Al‐Refaie, Waddah B.; Parsons, Helen; Markin, Abraham; Abrams, Jerome H.; Habermann, Elizabeth B.

doi:10.1016/j.surg.2012.06.008

Cited by 76 publications

(31 citation statements)

References 36 publications

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“…These findings are important because multiple studies have shown that greater numbers of perioperative blood transfusions in cancer patients are associated with increased rates of 30-day perioperative mortality, higher rates of major complications (such as deep vein thrombosis/PE), and prolonged length of stay. 2,53 In addition, a randomized prospective study of patients undergoing curative resection for colorectal cancer found that perioperative allogeneic blood transfusion was independently associated with tumor recurrence (relative risk of 6.18). 23 The average length of stay for our whole cohort was 9.7 days.…”

Section: Discussionmentioning

confidence: 99%

Posterior thoracic corpectomy with cage reconstruction for metastatic spinal tumors: comparing the mini-open approach to the open approach

Lau¹,

Chou²

2015

SPI

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OBJECT Spinal metastases most commonly affect the vertebral bodies of the spinal column, and spinal cord compression is an indication for surgery. Commonly, an open posterior approach is employed to perform a transpedicular costotransversectomy or lateral extracavitary corpectomy. Because of the short life expectancies in patients with metastatic spinal disease, decreasing the morbidity of surgical treatment and recovery time is critical. One potential approach to decreasing morbidity is utilizing minimally invasive surgery (MIS). Although significant advances have been made in MIS of the spine, data supporting the utility of MIS are still emerging. This study compared outcomes of patients who underwent mini-open versus traditional open transpedicular corpectomy for spinal metastases in the thoracic spine. METHODS A consecutive cohort from 2006 to 2013 of 49 adult patients who underwent thoracic transpedicular corpectomies for spinal metastases was retrospectively identified. Patients were categorized into one of 2 groups: open surgery and mini-open surgery. Mini-open transpedicular corpectomy was performed with a midline facial incision over only the corpectomy level of interest and percutaneous instrumentation above and below that level. The open procedure consisted of a traditional posterior transpedicular corpectomy. Chi-square test, 2-tailed t-test, and ANOVA models were employed to compare perioperative and follow-up outcomes between the 2 groups. RESULTS In the analysis, there were 21 patients who had mini-open surgery and 28 patients who had open surgery. The mean age was 57.9 years, and 59.2% were male. The tumor types encountered were lung (18.3%), renal/bladder (16.3%), breast (14.3%), hematological (14.3%), gastrointestinal tract (10.2%), prostate (8.2%), melanoma (4.1%), and other/unknown (14.3%). There were no significant intergroup differences in demographics, comorbidities, neurological status (American Spinal Injury Association [ASIA] grade), number of corpectomies performed, and number of levels instrumented. The open group had a mean operative time of 413.6 minutes, and the mini-open group had a mean operative time of 452.4 minutes (p = 0.329). Compared with the open group, the mini-open group had significantly less blood loss (917.7 ml vs 1697.3 ml, p = 0.019) and a significantly shorter hospital stay (7.4 days vs 11.4 days, p = 0.001). There was a trend toward a lower perioperative complication rate in the mini-open group (9.5%) compared with the open group (21.4%), but this was not statistically significant (p = 0.265). At follow-up, there were no significant differences in ASIA grade (p = 0.342), complication rate after the 30-day postoperative period (p = 0.999), or need for surgical revision (p = 0.803). The open approach had a higher overall infection rate of 17.9% compared with that in the mini-open approach of 9.5%, but this was not statistically significant (p = 0.409). CONCLUSIONS The mini-open transpedicular corpectomy is associated with less blood loss and shorter hospital stay compared with open transpedicular corpectomy. The mini-open corpectomy also trended toward lower infection and complication rates, but these did not reach statistical significance.

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Section: Discussionmentioning

confidence: 99%

Posterior thoracic corpectomy with cage reconstruction for metastatic spinal tumors: comparing the mini-open approach to the open approach

Lau¹,

Chou²

2015

SPI

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“…The volume categories for gastrectomy were low (1-2 cases/year), medium (3-5 cases/year), and high (≥6 cases/year). The volume categories for pancreatectomy were low (1-4 cases/year), medium (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) cases/year), and high (≥20 cases/year).…”

Section: Surgeon-level Factorsmentioning

confidence: 99%

Significant Variation in Blood Transfusion Practice Persists following Upper GI Cancer Resection

Aquina

Blumberg

Probst

et al. 2015

Journal of Gastrointestinal Surgery

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Significant variation in perioperative blood transfusion utilization is present at both the surgeon and hospital level. These findings are unexplained by patient-level factors and other known hospital characteristics, suggesting that variation is due to provider preferences and/or lack of standardized transfusion protocols. Implementing institutional transfusion guidelines is necessary to limit unwarranted variation and reduce infectious complication rates.

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“…10,13 The results from our review indicate that receiving blood transfusion is protective against unplanned readmission. 21 A potential explanation for this finding may be that although blood transfusion is often associated with higher rates of postoperative complications, morbidity, and mortality, 1,18,21,29 it may be an effective way of dealing with those complications before leaving the hospital. That is, a patient who undergoes a large vascular spinal fusion procedure may be appropriately treated with blood transfusion.…”

mentioning

confidence: 99%

Causes of 30-day readmission after neurosurgery of the spine

Cusimano

Pshonyak

Lee

et al. 2016

SPI

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OBJECT Thirty-day readmission has been cited as an important indicator of the quality of care in several fields of medicine. The aim of this systematic review was to examine rate of readmission and factors relevant to readmission after neurosurgery of the spine. METHODS The authors carried out a systematic review using several databases, searches of cited reference lists, and a manual search of the JNS Publishing Group journals (Journal of Neurosurgery; Journal of Neurosurgery: Spine; Journal of Neurosurgery: Pediatrics; and Neurosurgical Focus), Neurosurgery, Acta Neurochirurgica, and Canadian Journal of Neurological Sciences. A quality review was performed using STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) criteria and reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS A systematic review of 1136 records published between 1947 and 2014 revealed 31 potentially eligible studies, and 5 studies met inclusion criteria for content and quality. Readmission rates varied from 2.54% to 14.7%. Sequelae that could be traced back to complications that arose during neurosurgery of the spine were a prime reason for readmission after discharge. Increasing age, poor physical status, and comorbid illnesses were also important risk factors for 30-day readmission. CONCLUSIONS Readmission rates have predictable factors that can be addressed. Strategies to reduce readmission that relate to patient-centered factors, complication avoidance during neurosurgery, standardization with system-wide protocols, and moving toward a culture of nonpunitive system-wide error and “near miss” investigations and quality improvement are discussed.

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Blood transfusion and cancer surgery outcomes: A continued reason for concern

Cited by 76 publications

References 36 publications

Posterior thoracic corpectomy with cage reconstruction for metastatic spinal tumors: comparing the mini-open approach to the open approach

Posterior thoracic corpectomy with cage reconstruction for metastatic spinal tumors: comparing the mini-open approach to the open approach

Significant Variation in Blood Transfusion Practice Persists following Upper GI Cancer Resection

Causes of 30-day readmission after neurosurgery of the spine

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