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

Abstract

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.)

Resultados De La Implantación De Un Protocolo De Corrección De Anemia Preoperatoria en La Recuperación Intensificada De Cirugía Colorrectal Electiva

“…La transfusión sanguínea en QCR genera mucha controversia porque varios estudios han demostrado que se asocia con un aumento de la estancia hospitalaria, las complicaciones, los costes y la mortalidad 8,[22][23][24][25] . Algunos estudios, además, con-cluyen que la transfusión sanguínea aumenta la recurrencia de los CCR 23 aunque otros desmienten la afirmación 26 .…”

Cornerstones of patient blood management in surgery

“…Red blood cell transfusion is a reliable and life‐saving intervention that is effective in replacing blood loss, but in the non‐bleeding patient, although it may ‘top‐up’ haemoglobin (Hb) levels, it does not address the underlying cause of anaemia. Increasing evidence accumulated over the past few years shows that transfusion is independently associated with increased morbidity, mortality, quality of life and length of hospital stay across various surgical populations (Hofmann et al, ; Kotzé et al, ; Keeler et al, ; Papageorge et al, ). There are concerns surrounding the increased risk of transfusion‐associated circulatory overload (TACO), as well as sepsis, and cancer recurrence in oncology patients.…”

“…Timely identification and appropriate management of pre‐operative anaemia as indicated in PBM mandates have been shown to reduce the need for perioperative blood transfusions, even with modest rises in Hb levels (Papageorge et al, ). In a systematic review of above 20 000 patients with colorectal cancer, Acheson and his colleagues found that 58·8% of patients received blood transfusions (Acheson et al ., 2012).…”

Perioperative Anemia Management

“…3 While blood transfusion is currently considered the normal course of treatment, 4 this may compound risk as transfusion is itself associated with increased risk of adverse outcomes. 5 The most common cause for anemia in the preoperative patient is iron deficiency, which can be absolute (due to nutritional deficiency and blood loss) or indirect (by inflammatory mediated disruption in iron transport leading to a state of functional iron deficiency). 6 In 2016, the National Institute for Health and Care Excellence (NICE) reviewed transfusion practices and recommended the timely identification of anemia before surgery and consideration of alternatives to transfusion (NICE NG 24 QS 138).…”