Effect of Perioperative Transfusion on Recurrence and Survival after Gastric Cancer Resection: A 7-Institution Analysis of 765 Patients from the US Gastric Cancer Collaborative

Squires, Malcolm H.; Kooby, David A.; Poultsides, George A.; Weber, Sharon M.; Bloomston, Mark; Fields, Ryan C.; Pawlik, Timothy M.; Votanopoulos, Konstantinos I.; Schmidt, Carl; Ejaz, Aslam; Acher, Alexandra W.; Worhunsky, David J.; Saunders, Neil; Levine, Edward A.; Jin, Linda X.; Cho, Clifford S.; Winslow, Emily R.; Russell, Maria C.; Staley, Charles A.; Maithel, Shishir K.

doi:10.1016/j.jamcollsurg.2015.06.012

Cited by 76 publications

(54 citation statements)

References 24 publications

(25 reference statements)

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“…Although our series reports 60‐day morbidity and mortality, which tend to be higher, the numbers are still higher than the 90‐day results reported in a recent Japanese study with over 100 000 patients . Our numbers resemble though the early outcomes of American series, both from population‐based studies and from selected institutions cohorts where a radical resection was routinely performed. These disparities are probably related to the higher number of proximal and more advanced cases in Western series, along with higher BMI levels …”

Section: Discussioncontrasting

confidence: 38%

“…For model building, a group of 10 variables was initially forced into the model, based on prior knowledge of their impact on the outcomes. These variables were age, COPD, CHD, chronic liver disease, CCI, ASA classification, pancreas and spleen resection, blood transfusion, and extent of resection . All the other variables described in Section were analyzed then, following a stepwise selection algorithm, with different significance levels to entry (0.10) and stay (0.05).…”

Section: Methodsmentioning

confidence: 99%

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Predicting overall and major postoperative morbidity in gastric cancer patients

Coimbra

Jesus

Franco

et al. 2019

Journal of Surgical Oncology

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Background Postoperative complications after gastric cancer resection vary in different series and they might have a significant impact in long‐term outcomes. Our aim was to build a prediction rule on gastric cancer patients' overall and major morbidity risks. Methods This retrospective study included 1223 patients from a single center who were resected between 1992 and 2016. Overall and major morbidity predictors were identified through multiple logistic regression. Models' performances were assessed through discrimination, calibration, and cross‐validation, and nomograms were constructed. Results The mean age was 61.3‐year old and the male gender was more frequent (60%). The most common comorbidities were hypertension (HTN), diabetes, and chronic obstructive pulmonary disease (COPD). A D2‐distal gastrectomy was the most frequent procedure and 87% of all lesions were located in the middle or distal third. Age, COPD, coronary heart disease, chronic liver disease, pancreatic resection, and operative time were independent predictors of overall and major morbidity. The extent of resection and splenectomy was associated with overall events and HTN with major ones. Both models were very effective in predicting events among patients at higher risk. Conclusions The overall and major morbidity models and nomograms included clinical‐ and surgical‐related data that were very effective in predicting events, especially for high‐risk patients.

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Section: Discussioncontrasting

confidence: 38%

Section: Methodsmentioning

confidence: 99%

Predicting overall and major postoperative morbidity in gastric cancer patients

Coimbra

Jesus

Franco

et al. 2019

Journal of Surgical Oncology

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“…Recent studies also have described an association between liberal transfusion policies and increased incidence of health care‐associated infections, including surgical site infections and sepsis . Other studies have implicated high PLT dosing as a risk factor for transfusion‐associated adverse events, and transfusions in patients with certain gastrointestinal and other metastatic diseases may be associated with reduced chances of remission and survival . It is possible that clinical recommendations supported by these studies have motivated the decreased demand for blood products.…”

Section: Discussionmentioning

confidence: 99%

Continued decline in blood collection and transfusion in the United States–2015

et al. 2017

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BACKGROUND In 2011 and 2013, the National Blood Collection and Utilization Survey (NBCUS) revealed declines in blood collection and transfusion in the United States. The objective of this study was to describe blood services in 2015. STUDY DESIGN AND METHODS The 2015 NBCUS was distributed to all US blood collection centers, all hospitals performing at least 1000 surgeries annually, and a 40% random sample of hospitals performing 100 to 999 surgeries annually. Weighting and imputation were used to generate national estimates for units of blood and components collected, deferred, distributed, transfused, and outdated. RESULTS Response rates for the 2015 NBCUS were 78.4% for blood collection centers and 73.9% for transfusing hospitals. In 2015, 12,591,000 units of red blood cells (RBCs) (95% confidence interval [CI], 11,985,000‐13,197,000 units of RBCs) were collected, and 11,349,000 (95% CI, 10,592,000‐11,747,000) were transfused, representing declines since 2013 of 11.6% and 13.9%, respectively. Total platelet units distributed (2,436,000; 95% CI, 2,230,000‐2,642,000) and transfused (1,983,000; 95% CI, 1,816,000 = 2,151,000) declined by 0.5% and 13.1%, respectively, since 2013. Plasma distributions (3,714,000; 95% CI, 3,306,000‐4,121,000) and transfusions (2,727,000; 95% CI, 2,594,000‐2,859,000) in 2015 declined since 2013. The median price paid per unit in 2015—$211 for leukocyte‐reduced RBCs, $524 for apheresis platelets, and $54 for fresh frozen plasma—was less for all components than in 2013. CONCLUSIONS The 2015 NBCUS findings suggest that continued declines in demand for blood products resulted in fewer units collected and distributed Maintaining a blood inventory sufficient to meet routine and emergent demands will require further monitoring and understanding of these trends.

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“…Malnutrition, extent of resection, and blood transfusion have been recognized as important contributors to morbidity. Blood transfusions in gastric cancer patients have also been associated with decreased recurrence-free and overall survival (33). While indication for resection is not a modifiable risk factor, it is important to recognize that even after adjustment for significant factors including emergency operation, non-malignant diagnoses were associated with increased morbidity.…”

Section: Discussionmentioning

confidence: 99%

Morbidity and Mortality After Gastrectomy: Identification of Modifiable Risk Factors

Martin

Das

Turrentine

et al. 2016

Journal of Gastrointestinal Surgery

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Background Morbidity after gastrectomy remains high. The potentially modifiable risk factors have not been well described. This study considers a series of potentially modifiable patient-specific and perioperative characteristics that could be considered to reduce morbidity and mortality after gastrectomy. Methods This retrospective cohort study includes adults in the ACS NSQIP PUF dataset who underwent gastrectomy between 2011 and 2013. Sequential multivariable models were used to estimate effects of clinical covariates on study outcomes including morbidity, mortality, readmission and reoperation. Results 3,678 patients underwent gastrectomy. A majority of patients had distal gastrectomy (N= 2,799, 76.1%) and had resection for malignancy (N= 2,316, 63.0%). 798 patients (21.7%) experienced a major complication. Reoperation was required in 290 patients (7.9%). 30-day mortality was 5.2%. Age (OR=1.01, 95% CI: 1.01–1.02, p=0.001), preoperative malnutrition (OR=1.65, 95% CI: 1.35–2.02, p<0.001), total gastrectomy (OR=1.63, 95% CI: 1.31–2.03, p<0.001), benign indication for resection (OR=1.60, 95% CI: 1.29–1.97, p<0.001), blood transfusion (OR=2.57, 95% CI: 2.10–3.13, p<0.001), and intraoperative placement of a feeding tubes (OR=1.28, 95% CI: 1.00–1.62, p=0.047) were independently associated with increased risk of morbidity. Association between tobacco use and morbidity was statistically marginal (OR=1.23, 95% CI: 0.99–1.53, p=0.064). All-cause postoperative morbidity had significant associations with reoperation, readmission, and mortality (all p<0.001). Conclusions Mitigation of perioperative risk factors including smoking and malnutrition as well as identified operative considerations may improve outcomes after gastrectomy. Postoperative morbidity has the strongest association with other measures of poor outcome: reoperation, readmission, and mortality.

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Effect of Perioperative Transfusion on Recurrence and Survival after Gastric Cancer Resection: A 7-Institution Analysis of 765 Patients from the US Gastric Cancer Collaborative

Cited by 76 publications

References 24 publications

Predicting overall and major postoperative morbidity in gastric cancer patients

Predicting overall and major postoperative morbidity in gastric cancer patients

Continued decline in blood collection and transfusion in the United States–2015

Morbidity and Mortality After Gastrectomy: Identification of Modifiable Risk Factors

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