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

Abstract

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.

Pringle Maneuver in Extended Liver Resection: A propensity score analysis

“…Patients who were operated with the PM also had a significantly shorter ICU stay and lower rate of major morbidity compared with those who were operated without the PM. This can be explained by less intraoperative bleeding, blood transfusion, and PHH 29,30 . Although the PM did not significantly affect hospital stay and mortality, a longer ICU stay and higher rate of major morbidity are associated with higher costs and an increased need for intervention or reoperation 33 .…”

“…Additionally, patients in the PM group had significantly lower PHH, which reflects the reduced need for postoperative transfusion compared with patients in the without PM group. Perioperative blood transfusion has increased the length of hospital stay, worsened postoperative outcomes, and increased morbidity in liver resection patients 29,30 .…”

“…Deciding to perform the PM during hepatectomy should be based on an individual bleeding risk assessment and operation technique and difficulties. Indeed, because the liver is more vulnerable to bleeding than to ischemia [29][30][31]35 , the PM should be considered for procedures with a high risk of excessive intraoperative bleeding, such as EH. However, the PM should be performed as quickly as possible to prevent clinically significant liver damage due to ischemia-reperfusion injury.…”

Patient blood management for liver resection: consensus statements using Delphi methodology

“…7,9,10 Unnecessary RBCT, either due to inappropriate indications for transfusion or lack of pre-operative optimization, expose patients to additional risks, impairs their recovery, increase healthcare costs, and results in waste of scarce resources, as evident in retrospective studies including a recent systematic review. 2,9,15,41,42 Comprehensive multidisciplinary PBM programs can effectively decrease the use of RBCTs, reduce costs, and improve outcomes, as demonstrated in orthopedic and cardiac surgery. [43][44][45] The successful implementation of PBM programs requires buy-in from physicians, standardization of care, as well as practice guidelines.…”

“…While there is a now large amount of literature reporting on the frequency, predictors, and repercussions of RBCT for LR, there is currently no guideline for PBM in this field. 2,7,10,15,41,42,48 This work presents a National expert consensus with recommendations specific to LR that encompass all phases of perioperative care, thereby filling a gap in PBM guidelines for hepato-biliary surgery.…”