Impact of Blood Transfusions and Transfusion Practices on Long-Term Outcome Following Hepatopancreaticobiliary Surgery

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• 作者：Aslam Ejaz ; Gaya Spolverato ; Yuhree Kim…
• 关键词：Transfusion ; Trigger ; Cancer ; Recurrence ; Outcomes
• 刊名：Journal of Gastrointestinal Surgery
• 出版年：2015
• 出版时间：May 2015
• 年：2015
• 卷：19
• 期：5
• 页码：887-896
• 全文大小：521 KB
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• 作者单位：Aslam Ejaz (1)
  Gaya Spolverato (2)
  Yuhree Kim (2)
  Georgios A. Margonis (2)
  Rohan Gupta (2)
  Neda Amini (2)
  Steven M. Frank (3)
  Timothy M. Pawlik (2)
  
  1. Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
  2. Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 665, Baltimore, MD, 21287, USA
  3. Department of Anesthesiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
  
• 刊物主题：Surgery; Gastroenterology;
• 出版者：Springer US
• ISSN：1873-4626

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.