文摘
Background The long-term impact of transfusions with packed red blood cells (PRBC) among patients undergoing hepatopancreaticobiliary (HPB) surgery remains ill-defined. We sought to determine the impact of overall blood utilization, as well as a restrictive transfusion strategy, on long-term outcomes among patients undergoing an HPB resection for a malignancy. Methods Data on overall blood utilization and hemoglobin (Hb) levels that triggered a transfusion were obtained for patients with cancer undergoing pancreas or liver surgery between 2009 and 2013. Risk-adjusted recurrence-free (RFS) and overall survival (OS) were assessed based on receipt of PRBC and whether the patient received a transfusion using a restrictive transfusion?strategy (intraoperative: Hb <10?g/dL; postoperative: Hb <8?g/dL). Results Four hundred forty-two patients underwent either a pancreas (58.1?%) or liver (41.9?%) resection. Most tumors were pancreatic in origin (41.8?%), while a subset were primary (23.1?%) or secondary (18.8?%) liver tumors. One hundred seventy-five (39.6?%) patients received ? PRBC transfusion either intraoperatively (16.7?%), postoperatively (12.7?%), or both (10.2?%). There was a higher incidence of PRBC transfusion among patients undergoing a pancreas resection, those with higher comorbidities, and those with lower preoperative Hb levels. Perioperative morbidity was higher among patients receiving either 1- units (OR 3.14) or 3 or more units of PRBC (OR 8.54). Median OS was 31.9?months. Receipt of a blood transfusion was associated with a worse OS (1- units: HR 1.76; 3-?units: HR 2.50; both P-lt;-.05), and RFS (3-?units: HR 2.91; P--.02). Utilization of a restrictive transfusion strategy did not impact perioperative morbidity or long-term RFS or OS. Conclusions Adoption of a more restrictive transfusion strategy in patients undergoing resection for cancer may preserve a limited resource, reduce costs, as well as avoid exposing oncology patients to the unnecessary risks associated with a transfusion.