Blood Transfusion in Major Abdominal Surgery for Malignant Tumors

Ecker, Brett L.; Simmons, Kristina D.; Zaheer, Salman; Poe, Sarah-Lucy C.; Bartlett, Edmund K.; Drebin, Jeffrey A.; Fraker, Douglas L.; Kelz, Rachel R.; Roses, Robert E.; Karakousis, Giorgos C.

doi:10.1001/jamasurg.2015.5094

Cited by 50 publications

(23 citation statements)

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“…A high frequency of patients with advanced gastric cancer present with anemia, and furthermore, gastrectomy with lymphadenectomy sometimes causes excessive bleeding even when performed by experienced surgeons (Birgegård et al 2005 ; Sasako et al 2008 ). Thus, allogeneic blood transfusion (BTF) is sometimes inevitable when performing D2 gastrectomy for advanced gastric cancer, although it is fair to say that the frequency of BTF is decreasing as a result of improvements in surgical techniques and peri-operative care (Ecker et al 2016 ). While BTF may be vital in some circumstances, there is growing evidence that BTF is associated with adverse long-term survival in oncological patients.…”

Section: Introductionmentioning

confidence: 99%

Impact of peri-operative blood transfusion on post-operative infections after radical gastrectomy for gastric cancer: a propensity score matching analysis focusing on the timing, amount of transfusion and role of leukocyte depletion

Xiao

Pan

et al. 2018

J Cancer Res Clin Oncol

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PurposeAllogeneic blood transfusions (BTF) are sometimes inevitable during radical gastrectomy with lymphadenectomy for advanced gastric cancer. The aim of this retrospective study was to investigate the association between BTF and post-operative infections, focusing on the impact of timing, amount of transfusion and the role of leukocyte depletion.MethodsThe study cohort was 2064 patients who underwent gastrectomy for gastric cancer from November 2010 to August 2017. The association between BTF and post-operative infections was estimated by univariate and multivariate analyses after propensity score matching. Subgroup analysis was performed according to the timing and amount of transfusion, and leukocyte depletion or not.ResultsOut of a total 2064 patients, 426 (20.6%) received peri-operative BTF. After one-to-one matching, 361 pairs of patients were included for further analysis, of who 68 (9.4%) developed infections. Multivariate analysis identified that an operation time ≥ 240 min, combined multi-organ resection, BTF and BMI ≥ 25 kg/m2 were independent risk factors for post-operative infection. Patients given a high-volume (> 7.5 U), intra-operatively of leukocyte-non-depleted BTF had the highest risk of developing infections clarified by subgroup analysis.ConclusionInfection was the most common complication following gastrectomy for gastric cancer and BTF was identified as an independent risk factor by propensity score matching and multivariate analyses. The timing, amount of transfusion and leukocyte depletion had an impact on the incidence of infection. To decrease infection, BTF should be avoided where possible, particularly during operation, with a large amount and leukocyte-not-depleted blood.

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Section: Introductionmentioning

confidence: 99%

Impact of peri-operative blood transfusion on post-operative infections after radical gastrectomy for gastric cancer: a propensity score matching analysis focusing on the timing, amount of transfusion and role of leukocyte depletion

Xiao

Pan

et al. 2018

J Cancer Res Clin Oncol

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“… 6 , 7 Thus, blood transfusions (BTF) can be a life-saving treatment during D2 gastrectomy for advanced GC, although the need for BTF is decreasing as a result of improvements in surgical techniques and peri-operative care. 8 While BTF may be vital in some circumstances, there is a growing body of evidence that BTF produces adverse actions on the prognosis in GC patients who had gastrectomy operations to cure GC. 9 – 12 Transfusion-related immunomodulation (TRIM) and systemic inflammation have been considered to play a pivotal role in these detrimental effects.…”

Section: Introductionmentioning

confidence: 99%

Peri-Operative Blood Transfusion Does Not Influence Overall and Disease-Free Survival After Radical Gastrectomy for Stage II/III Gastric Cancer: a Propensity Score Matching Analysis

Xiao

et al. 2018

Journal of Gastrointestinal Surgery

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ObjectiveWhether peri-operative blood transfusions (BTF) negatively impact long-term survival after gastrectomy for gastric cancer (GC) remains controversial. The aim of this retrospective study was to investigate independent predictive factors of BTF and the potential impact of BTF on overall survival (OS) and disease-free survival (DFS) in patients who underwent radical gastrectomy for stage II/III GC.MethodsOf 1020 patients who underwent gastrectomy for stage II/III GC from November 2010 to December 2015, 231 (22.6%) patients received BTF. The independent predictive factors of BTF were identified using univariate and multivariate analyses. Cox regression and propensity score matching (PSM) analyses of OS and DFS in patients who received BTF or not were compared.ResultsMultivariate analysis revealed that age, pre-operative hemoglobin levels, tumor size, operation time, combined multi-organ resection, and intra-operative blood loss were independent predictive factors for BTF. PSM analysis created 205 pairs of patients. BTF was significantly associated with decreased OS (P = 0.025) and DFS (P = 0.034) in the entire cohort before PSM. After PSM, there was no longer a significant association between BTF and OS (P = 0.850) or DFS (P = 0.880). BTF was not identified as an independent risk factor for OS or DFS by multivariate Cox regression analysis.ConclusionsThe present study revealed that BTF did not influence OS and DFS after radical gastrectomy for stage II/III GC. Worse oncological outcomes were caused by clinical circumstances requiring blood transfusions, including longer operation time and advanced tumor stage, not due to BTF itself.Electronic supplementary materialThe online version of this article (10.1007/s11605-018-3808-8) contains supplementary material, which is available to authorized users.

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“…However, patients requiring transfusion are often also at greater risk for postoperative morbidities and mortality [5], such as: blood borne infections, ABO incompatibility, hemolytic reactions, transfusion-associated circulatory overload, transfusion related acute lung injury, immunosuppression [6], increased risk of perioperative infection [7], and earlier recurrence of malignancies after resection [8,9]. Preoperative knowledge of likely patient transfusion requirements would improve blood resource management, inform clinicians of the likelihood for postoperative morbidities, lower cost by avoiding preoperative typing and crossing patients unlikely to need a transfusion, and could serve to further improve patient outcomes [10].…”

Section: Introductionmentioning

confidence: 99%

“…The ability to identify patients who would be most likely to receive blood transfusions could greatly help in perioperative and postoperative planning and preparation. Regression models have been previously used to predict or model operative and postoperative transfusions [10,11]. Besides regression, artificial neural networks (ANNs) are also a reliable choice for modeling and problem solving in medicine [12].…”

Section: Introductionmentioning

confidence: 99%

Prediction of perioperative transfusions using an artificial neural network

Walczak

Velanovich

2020

PLoS ONE

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Background Accurate prediction of operative transfusions is essential for resource allocation and identifying patients at risk of postoperative adverse events. This research examines the efficacy of using artificial neural networks (ANNs) to predict transfusions for all inpatient operations. Methods Over 1.6 million surgical cases over a two year period from the NSQIP-PUF database are used. Data from 2014 (750937 records) are used for model development and data from 2015 (885502 records) are used for model validation. ANN and regression models are developed to predict perioperative transfusions for surgical patients. Results Various ANN models and logistic regression, using four variable sets, are compared. The best performing ANN models with respect to both sensitivity and area under the receiver operator characteristic curve outperformed all of the regression models (p < .001) and achieved a performance of 70-80% specificity with a corresponding 75-62% sensitivity. Conclusion ANNs can predict >75% of the patients who will require transfusion and 70% of those who will not. Increasing specificity to 80% still enables a sensitivity of almost 67%. The unique contribution of this research is the utilization of a single ANN model to predict transfusions across a broad range of surgical procedures.

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Blood Transfusion in Major Abdominal Surgery for Malignant Tumors

Abstract: Over 9 years of contemporary practice, a trend of less perioperative blood transfusions for oncologic abdominal surgery was observed. Further studies are needed to assess whether these trends reflect changes in operative techniques, hospital cohorts, or transfusion thresholds.

Cited by 50 publications

References 24 publications

Impact of peri-operative blood transfusion on post-operative infections after radical gastrectomy for gastric cancer: a propensity score matching analysis focusing on the timing, amount of transfusion and role of leukocyte depletion

Impact of peri-operative blood transfusion on post-operative infections after radical gastrectomy for gastric cancer: a propensity score matching analysis focusing on the timing, amount of transfusion and role of leukocyte depletion

Peri-Operative Blood Transfusion Does Not Influence Overall and Disease-Free Survival After Radical Gastrectomy for Stage II/III Gastric Cancer: a Propensity Score Matching Analysis

Prediction of perioperative transfusions using an artificial neural network

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