The Impact of Perioperative Red Blood Cell Transfusions on Long-Term Outcomes after Hepatectomy for Colorectal Liver Metastases

Hallet, Julie; Tsang, Melanie; Cheng, Emily YiQin; Habashi, Rogeh; Kulyk, Iryna; Hanna, Sherif S.; Coburn, Natalie; Lin, Yulia; Law, Calvin; Karanicolas, Paul J.

doi:10.1245/s10434-015-4477-4

Cited by 71 publications

(75 citation statements)

References 34 publications

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“…Almost a third of the patients in the study did not have a malignancy. Although multiple studies examining associations between liver resection for malignancy and blood transfusions have demonstrated the adverse impact on oncologic outcomes when blood products are used [17–21], few studies have established whether or not blood transfusion poses an additional risk for hepatectomy patients undergoing resection for a non-oncologic indication [1, 22]. In our study, transfusion use did not differ between patients undergoing resection for malignancy and non-malignant diagnoses.…”

Section: Discussionmentioning

confidence: 47%

Blood transfusion is an independent predictor of morbidity and mortality after hepatectomy

Martin

Kerwin

Turrentine

et al. 2016

Journal of Surgical Research

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Background Previous studies have indicated that blood transfusion is associated with increased risk of worse outcomes among patients selected for hepatectomy. However, the independent effect of transfusion has not been confirmed. We hypothesize that blood transfusion is an independent factor that affects outcomes in patients undergoing hepatectomy. Materials and Methods Patients at tertiary care center who underwent hepatectomy between 2006 and 2013 were identified and linked with the ACS-NSQIP PUF dataset. Multivariable logistic regression analysis was used to estimate the effect of blood transfusion on 30-day mortality and morbidity, adjusted for differences in extent of resection and estimated probabilities of morbidity and mortality. Results Among 522 patients in the study, 48 (9.2%) patients required perioperative blood transfusion within 72 hours of resection, and 172 (33%) underwent major hepatectomy. Indications for hepatectomy included metastatic neoplasm (n=229, 44%), primary hepatic neoplasm (n=108, 21%), primary extra-hepatic biliary neoplasm (n=23, 4%), and non-malignant indications (n=162, 31%). Eighty-eight (17%) patients had a postoperative morbidity. Blood transfusion was significantly associated with postoperative morbidity (OR 4.18, 95% CI 2.18–8.02, p=0.0001) and mortality (OR 14.5, 95% CI 3.08–67.8, p=001), after adjustment for the concurrent effect of NSQIP estimated probability of morbidity (OR 1.15, 95% CI 0.11–12.2, p=0.042). The extent of resection was not significantly associated with morbidity (OR 1.30, 95% CI 0.74–2.28, p=0.366) or mortality (OR 1.14, 95% CI 0.24–5.50, p=0.870). Conclusions Blood transfusion is a highly statistically significant independent predictor of morbidity and mortality after hepatectomy. Judicious use of perioperative transfusion is indicated in patients with benign and malignant indications for liver resection.

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Section: Discussionmentioning

confidence: 47%

Blood transfusion is an independent predictor of morbidity and mortality after hepatectomy

Martin

Kerwin

Turrentine

et al. 2016

Journal of Surgical Research

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“…All identified studies were observational design studies involving a total of 10621 patients. Seven studies were from USA [5, 7, 9, 16, 21, 22, 24], four from Italy [4, 8, 12, 13], three from Japan [3, 14, 18], two from UK [11, 25], two from Germany [20, 23], one from Sweden [2], one from France [6], one from Spain [10], one from Brazil [15], one from China [17], one from Canada [19], and one from the Netherlands [26]. The blood product transfusion rate was highly variable across studies ranging from 13.5% to 91.5%.…”

Section: Resultsmentioning

confidence: 99%

“…Four studies compared the characteristics of transfused patients versus those nontransfused patients [16, 19–21]. Pooled analysis showed that transfusion was associated with female gender ( P <0.001), higher prevalent preoperative anemia ( P <0.001), more extended or major hepatectomy ( P <0.001), increased estimated blood loss ( P <0.001), and longer duration of surgery ( P <0.001).…”

Section: Resultsmentioning

confidence: 99%

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Impact of perioperative blood transfusion on clinical outcomes in patients with colorectal liver metastasis after hepatectomy: a meta-analysis

Lyu

Qiao

et al. 2017

Oncotarget

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BACKGROUNDPerioperative blood transfusion may be associated with negative clinical outcomes in oncological surgery. A meta-analysis of published studies was conducted to evaluate the impact of blood transfusion on short- and long-term outcomes following liver resection of colorectal liver metastasis (CLM).MATERIALS AND METHODSA systematic search was performed to identify relevant articles. Data were pooled for meta-analysis using Review Manager version 5.3.RESULTSTwenty-five observational studies containing 10621 patients were subjected to the analysis. Compared with non-transfused patients, transfused patients experienced higher overall morbidity (odds ratio [OR], 1.98; 95% confidence intervals [CI] =1.49-2.33), more major complications (OR, 2.12; 95% CI =1.26-3.58), higher mortality (OR, 4.13; 95% CI =1.96-8.72), and longer length of hospital stay (weighted mean difference, 4.43; 95% CI =1.15-7.69). Transfusion was associated with reduced overall survival (risk ratio [RR], 1.24, 95% CI =1.11-1.38) and disease-free survival (RR, 1.38, 95% CI=1.23-1.56).CONCLUSIONPerioperative blood transfusion has a detrimental impact on the clinical outcomes of patients undergoing CLM resection.

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“…However, blood loss remains a significant concern and has been the topic of numerous studies (3)(4)(5). As a result, red blood cell transfusions (RBCT) are required in up to 25% of patients undergoing liver resection (6)(7)(8). Thus, hepatectomy represents a unique challenge with regards to blood management strategies.…”

Section: Introductionmentioning

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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The Impact of Perioperative Red Blood Cell Transfusions on Long-Term Outcomes after Hepatectomy for Colorectal Liver Metastases

Abstract: Perioperative RBCT is independently associated with decreased OS and RFS following hepatectomy for CRLM. Interventions to minimize and rationalize the use of RBCT for hepatectomy are warranted to mitigate this detrimental effect on long-term outcomes.

Cited by 71 publications

References 34 publications

Blood transfusion is an independent predictor of morbidity and mortality after hepatectomy

Blood transfusion is an independent predictor of morbidity and mortality after hepatectomy

Impact of perioperative blood transfusion on clinical outcomes in patients with colorectal liver metastasis after hepatectomy: a meta-analysis

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

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