Identification of predictive factors for perioperative blood transfusion in colorectal resection patients

Abstract

Hematocrit less than 30 is an independent risk factor for requiring perioperative blood transfusion, and patients with hematocrit less than 30 should be considered for autologous blood transfusion and erythropoietin.

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

“…Surprisingly, older age appeared to be associated with transfusion requirements only on univariate analysis but was not a predictor in the logistic regression model, in contrast to the studies by Nilsson et al 21 and Kim el al. 7 Also in contrast to Nilsson et al's study, we did not find gender, chronic kidney disease, and chronic obstructive pulmonary disease to be independent predictors of blood transfusions. This may be explained by the fact that our model took into account more variables, and the stronger effects of some variables on blood transfusion requirement may have concealed the effects of less predictive variables.…”

“…Earlier series from the 1980s reported blood transfusion rates of 39% to 74%3-5 in colorectal cancer surgery, while more recent studies have reported rates between 20% and 28%. [6][7][8] Although there is extensive data regarding the detrimental effects of blood transfusions on disease-free and overall survival after colorectal cancer, [9][10][11][12][13] it is interesting to note that only a few studies have examined the effects of blood transfusions on short-term outcomes after colorectal cancer resections. Most of these studies have shown that blood transfusions were associated with higher infection rates, prolonged ventilator assistance, longer lengths of stay, increased mortality, and increased morbidity.…”

“…These risk factors have been examined in smaller series with some discrepancies. 7,21,25 To date, there is no predictive model or nomogram evaluating the requirement for perioperative blood transfusions in patients with colorectal cancer.…”

Is it time to integrate patient blood management in ERAS guidelines?

“…However, the prevalence of anaemia in patients with colorectal cancer is 30-75%, depending on the haemoglobin level and staging used to define this level 3,4 . Anaemia is the most important predictive factor for allogenic blood transfusion (ABT) 5 . It is associated with increased postoperative morbidity and length of stay 6 , secondary to ABT itself, as well as inadequate tissue perfusion by alteration in oxygen delivery which could lead to organ dysfunction.…”

Short course pre-operative ferrous sulphate supplementation – is it worthwhile in patients with colorectal cancer?

“…Preoperative anaemia is well recognised in patients presenting with colorectal cancer, with recent series suggesting a prevalence of iron deficiency in 60% 2 and an associated anaemia in up to 38% 3 of new presentations. Pre-operative anaemia is recognised as a predictive factor for blood transfusion, 4,5 as well as a predictor of adverse outcomes in surgical patients. Carson et al 6 demonstrated that overall mortality increases as the haemoglobin concentration decreases, with even mild anaemia conferring an increased death risk.…”