Blood transfusions in colorectal cancer surgery: incidence, outcomes, and predictive factors: an American College of Surgeons National Surgical Quality Improvement Program analysis

Halabi, Wissam J.; Jafari, Mehraneh D.; Nguyen, Vinh; Carmichael, Joseph C.; Mills, Steven; Pigazzi, Alessio; Stamos, Michael J.

doi:10.1016/j.amjsurg.2013.10.001

Cited by 72 publications

(49 citation statements)

References 31 publications

(40 reference statements)

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“…Bernard and colleagues demonstrated that one unit of packed red blood cells significantly increased the risk of morbidity, mortality, pneumonia and sepsis [14]. Halabi et al confirmed these findings in a more recent analysis and demonstrated that blood transfusions were independently associated with increased morbidity, mortality, length of stay and SSI [11]. …”

Section: Discussionmentioning

confidence: 99%

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Perioperative blood transfusion in gynecologic oncology surgery: Analysis of the National Surgical Quality Improvement Program Database

Prescott

Aloia

Brown

et al. 2015

Gynecologic Oncology

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Objective To use a large-scale multi-institutional dataset to quantify the prevalence of packed red blood cell transfusions and examine the associations between transfusion and perioperative outcomes in gynecologic cancer surgery. Methods The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) participant use file was queried for all gynecologic cancer cases between 2010 and 2012. Demographic, preoperative and intraoperative variables were compared between transfusion and non-transfusion groups using chi-squared, Fisher’s exact and Wilcoxon rank-sum test. The primary endpoint was 30-day composite morbidity. Secondary endpoints included composite surgical site infections, mortality and length of stay. Results A total of 8,519 patients were analyzed, and 13.8% received a packed red blood cell transfusion. In the multivariate analysis, after adjusting for key clinical and perioperative factors, including preoperative anemia and case magnitude, transfusion was associated with higher composite morbidity (OR = 1.85, 95% CI 1.5 – 2.24), surgical site infections (OR 1.80, 95% CI 1.39 – 2.35), mortality (OR 3.38, 95% CI 1.80 – 6.36) and length of hospital stay (3.02 days v. 7.17 days, p <0.001). Conclusions Blood transfusions are associated with increased surgical wound infections, composite morbidity and mortality. Based on our analysis of the NSQIP database, transfusion practices in gynecologic cancer should be scrutinized. Examination of institutional practices and creation of transfusion guidelines for gynecologic malignancies could potentially result in better utilization of blood bank resources and clinical outcomes among patients.

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Section: Discussionmentioning

confidence: 99%

“…Although there have been no randomized controlled trials in oncology patients, there is ample evidence in the colorectal cancer surgery literature to suggest that blood transfusions themselves are immunosuppressive and associated with increased rates of infection, perioperative morbidity, disease progression and mortality [11, 12]. …”

Section: Introductionmentioning

confidence: 99%

Perioperative blood transfusion in gynecologic oncology surgery: Analysis of the National Surgical Quality Improvement Program Database

Prescott

Aloia

Brown

et al. 2015

Gynecologic Oncology

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“…These values include factors, such as hemoglobin levels, total blood loss, and operative time, which are traditionally believed to be predictive for administering a transfusion. 10, 11, 12, 13 …”

Section: Discussionmentioning

confidence: 99%

Restrictive blood transfusion protocol in malignant upper gastrointestinal and pancreatic resections patients reduces blood transfusions with no increase in patient morbidity

Wehry

Agle

Philips

et al. 2015

The American Journal of Surgery

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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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“…Like anemia itself, perioperative blood transfusions in surgical patients also has been associated with increased risk of postoperative complications, greater mortality, and greater duration of hospital stay. 8,9 Additionally, and particularly relevant in the treatment of patients with colorectal cancer, blood transfusion is associated with worse, long-term oncologic outcomes. 10 …”

mentioning

confidence: 99%

“…An estimated 14–28% of patients undergoing surgery for colorectal cancer receive a perioperative transfusion, 8 but the threshold at which transfusion is indicated is poorly defined. 7,11 In the trial titled Transfusion Requirements in Critical Care, critically ill patients who were randomized to a restrictive blood transfusion protocol had improved in-hospital outcomes compared to those managed according to a more liberal transfusion protocol, particularly among patients <55 years of age and with less severe disease.…”

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confidence: 99%

Preoperative blood transfusion is a predictor of worse short-term postoperative outcomes after colectomy

Papageorge

Kennedy

Carchman

2017

Surgery

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Background Both anemia and blood transfusion are associated with poor outcomes. The aim of this study was to evaluate the effect of preoperative blood transfusion on postoperative outcomes after colectomy, stratified by severity of anemia. Methods Patients undergoing colectomy from 2012–2014 were selected from the National Surgical Quality Improvement Program targeted colectomy database. Patients were divided into 2 groups based on receipt of preoperative transfusion and then stratified by hematocrit. Univariate and multivariate analyses were used to compare 30-day outcomes between the 2 groups. Results A total of 60,785 patients were included in the study, with an overall preoperative transfusion rate of 3.4% (n = 2,073). On univariate analysis, transfusion was associated with significantly greater rates of postoperative morbidity. The risk-adjusted, multivariate model confirmed increased risk of complications with preoperative transfusion (odds ratio 1.32, 95% confidence interval, 1.18–1.48). Furthermore, transfusion did not improve outcomes even in the setting of moderate anemia (odds ratio 1.35, 95% confidence interval, 1.14–1.60) or severe anemia (odds ratio 0.97, 95% confidence interval, 0.66–1.41). Conclusions Preoperative transfusion is an independent predictor of complications in patients with mild and moderate anemia. Furthermore, these retrospective data suggest that even severely anemic patients do not benefit from preoperative transfusion and empiric transfusion therefore should be avoided. Alternatives to preoperative optimization of this high-risk surgical population should be sought. (Surgery 2017;161:1067-75.)

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Blood transfusions in colorectal cancer surgery: incidence, outcomes, and predictive factors: an American College of Surgeons National Surgical Quality Improvement Program analysis

Abstract: BTs are associated with worse short-term outcomes after CRC surgery. Knowledge of predictive factors will help in risk stratification and counseling.

Cited by 72 publications

References 31 publications

Perioperative blood transfusion in gynecologic oncology surgery: Analysis of the National Surgical Quality Improvement Program Database

Perioperative blood transfusion in gynecologic oncology surgery: Analysis of the National Surgical Quality Improvement Program Database

Restrictive blood transfusion protocol in malignant upper gastrointestinal and pancreatic resections patients reduces blood transfusions with no increase in patient morbidity

Preoperative blood transfusion is a predictor of worse short-term postoperative outcomes after colectomy

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