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

Wehry, John; Agle, Steven C.; Philips, Prejesh; Cannon, Robert M.; Scoggins, Charles R.; Puffer, Lisa; McMasters, Kelly M.; Martin, Robert C.G.

doi:10.1016/j.amjsurg.2015.08.013

Cited by 13 publications

(16 citation statements)

References 22 publications

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“…Of the 14 articles retrieved for full-text review 6 studies involving 983 participants were included for the final review: 3 randomized controlled trials [38–40] and 3 nonrandomized studies. [26, 27, 41]…”

Section: Resultsmentioning

confidence: 99%

“…Three studies took place in the context of chemotherapy [38, 40, 41] and three studies were in the context of surgery. [26, 27, 39] Transfusion strategies were evaluated in several different types of cancer including leukemia,[40, 41] gastric,[38] colorectal,[26] hepatobilliary,[27] and mixed surgical oncology patients. [39] Two studies were conducted in the United States,[26, 27] one in Brazil,[39] one in Canada,[40] one in the Netherlands[41] and one in Korea.…”

Section: Resultsmentioning

confidence: 99%

“…[38] There was significant heterogeneity in the definition of restrictive and liberal transfusion strategies with overlap between studies. The restrictive strategies ranged from use of a hemoglobin trigger of 7 g/dL [27, 39] to 8 g/dL[40] to 10 g/dL. [38] One study utilized age-dependent transfusion triggers ranging from 7.2 g/dL to 8.0 g/dL[41] and one used an individualized approach with no specific trigger.…”

Section: Resultsmentioning

confidence: 99%

“…[21–23] Evidence from institutional quality improvement initiatives has demonstrated that restrictive strategies have similar clinical outcomes while utilizing less blood. [21–27]…”

Section: Introductionmentioning

confidence: 99%

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How low should we go: A systematic review and meta-analysis of the impact of restrictive red blood cell transfusion strategies in oncology

Prescott

Taylor

López-Olivo

et al. 2016

Cancer Treatment Reviews

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Background Most non-oncologic clinical practice guidelines recommend restrictive allogeneic blood transfusion practices; however, there is a lack of consensus regarding the best transfusion practice in oncology. We conducted a systematic review of the literature to compare the efficacy and safety of restrictive versus liberal transfusion strategies in patients with cancer. Methods A literature search using MEDLINE, PUBMED and EMBASE identified all controlled studies comparing the use of restrictive with liberal transfusion in adult oncology participants up to August 10, 2015. Two review authors independently assessed studies for inclusion, extracted data and appraised the quality of the included studies. The primary outcomes of interest were blood utilization and all-cause mortality. Results Out of 4241 citations, six studies (3 randomized and 3 non-randomized) involving a total of 983 patients were included in the final review. The clinical context of the studies varied with 3 chemotherapy and 3 surgical studies. The overall risk of bias in all studies was moderate to high. Restrictive transfusion strategies were associated with a 36% reduced risk of receiving a perioperative transfusion (risk ratio (RR) 0.64, 95% confidence interval (CI) 0.49 to 0.83). There was no difference in mortality between the strategies (RR 1.00, 95% CI 0.32 to 3.18). There were no differences in adverse events reported between the restrictive and liberal transfusion strategies. Conclusion Restrictive strategy appears to decrease blood utilization without increasing morbidity or mortality in oncology. This review is limited by a paucity of high quality studies on this topic. Better designed studies are warranted.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…[21–23] Evidence from institutional quality improvement initiatives has demonstrated that restrictive strategies have similar clinical outcomes while utilizing less blood. [21–27]…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

How low should we go: A systematic review and meta-analysis of the impact of restrictive red blood cell transfusion strategies in oncology

Prescott

Taylor

López-Olivo

et al. 2016

Cancer Treatment Reviews

View full text Add to dashboard Cite

show abstract

“…Comprehensive blood management programs can effectively reduce the use of perioperative RBCT as well as improve post-operative outcomes and save costs (41)(42)(43)(44). However, the successful implementation of these programs requires buy-in from primary stakeholders caring for the patients.…”

Section: Discussionmentioning

confidence: 99%

The impact of perioperative blood transfusions on short-term outcomes following hepatectomy

Hallet¹,

Mahar²,

Nathens³

et al. 2018

Hepatobiliary Surg. Nutr.

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Background: Bleeding and need for red blood cell transfusions (RBCT) remain a significant concern with hepatectomy. RBCT carry risk of transfusion-related immunomodulation that may impact post-operative recovery. This study soughs to assess the association between RBCT and post-hepatectomy morbidity. Two exposure groups were created based on RBCT. Primary outcomes were 30-day major morbidity and mortality. Secondary outcomes included 30-day system-specific morbidity and length of stay (LOS). Relative risks (RR) with 95% confidence interval (95% CI) were computed using regression analyses. Sensitivity analyses were conducted to understand how missing data might have impacted the results.Results: A total of 12,180 patients were identified. Of those, 11,712 met inclusion criteria, 2,951 (25.2%) of whom received RBCT. Major morbidity occurred in 14.9% of patients and was strongly associated with RBCT (25.3% vs. 11.3%; P<0.001). Transfused patients had higher rates of 30-day mortality (5.6% vs. 1.0%; P<0.0001). After adjustment for baseline and clinical characteristics, RBCT was independently associated with increased major morbidity (RR 1.80; 95% CI: 1.61-1.99), mortality (RR 3.62; 95% CI: 2.68-4.89), and 1.29 times greater LOS (RR 1.29; 95% CI: 1.25-1.32). Results were robust to a number of sensitivity analyses for missing data.Conclusions: Perioperative RBCT for hepatectomy was independently associated with worse shortterm outcomes and prolonged LOS. These findings further the rationale to focus on minimizing RBCT for hepatectomy, when they can be avoided.

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Combined pre-operative risk score predicts pancreatic leak after pancreatic resection

Clements,

Philips,

Egger

et al. 2023

Surg Endosc

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

Cited by 13 publications

References 22 publications

How low should we go: A systematic review and meta-analysis of the impact of restrictive red blood cell transfusion strategies in oncology

How low should we go: A systematic review and meta-analysis of the impact of restrictive red blood cell transfusion strategies in oncology

The impact of perioperative blood transfusions on short-term outcomes following hepatectomy

Combined pre-operative risk score predicts pancreatic leak after pancreatic resection

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