516 BLOOD LOSS DURING RADICAL CYSTECTOMY AND CONCOMITANT TRANSFUSIONS: INFLUENCING FACTORS AND IMPACT ON PATIENT OUTCOMES

Abstract

You have accessJournal of UrologyUrothelial Cancer: Medical & Surgical Therapy1 Apr 2013516 BLOOD LOSS DURING RADICAL CYSTECTOMY AND CONCOMITANT TRANSFUSIONS: INFLUENCING FACTORS AND IMPACT ON PATIENT OUTCOMES Anirban P Mitra, Eila C. Skinner, Anne K. Schuckman, Gus Miranda, and Siamak Daneshmand Anirban P MitraAnirban P Mitra Los Angeles, CA More articles by this author , Eila C. SkinnerEila C. Skinner Stanford, CA More articles by this author , Anne K. SchuckmanAnne K. Schuckman Los Angeles, CA More articles by this author , Gus MirandaGus Miranda Los Angeles, CA More articles by this author , and Siamak DaneshmandSiamak Daneshmand Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1910AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical cystectomy is a major surgical procedure that is associated with significant blood loss (BL) and lengthy hospital stays. This study examined factors associated with BL during cystectomy, its impact on transfusions, and influence of such loss and associated transfusions on prognosis. METHODS Patients who underwent open radical cystectomy for bladder cancer during 1983-2009 were reviewed. Influence of pre-cystectomy, intra-operative, and tumor-associated factors on BL and peri-/post-op transfusions were assessed by univariable and multivariable models. Associations of BL with transfusions, and influence of these factors on outcomes were also examined. RESULTS 1,242 patients were identified (medians: age, 67 years; follow-up, 8.5 years; BL, 900 mL). Among pre-cystectomy factors, females (p = 0.002) and patients with advanced clinical stage (p = 0.024) experienced greater BL. No associations with pre-op labs and ASA scores were identified. Prolonged anesthesia time was associated with increased BL (p < 0.001). Continent urinary diversions, ≥50 lymph nodes dissected (both, p = 0.002), and intra-op complications (p = 0.005) were also associated with greater BL. Patients receiving transfusions had higher median BL (1L vs. 700 mL, p < 0.001). Greater proportion of females, older patients, those with low pre-op hemoglobin, hematocrit and albumin, high ASA scores, longer anesthesia times, and high nodal yields received transfusions (all, p < 0.001). Patients with advanced clinical stage were more likely to be transfused, and this was associated with longer hospital stays (both, p = 0.030). By multivariable analysis, higher clinical stage (p = 0.033), prolonged anesthesia time (p = 0.018), and intra-op complications (p < 0.001) were associated with greater BL; increased loss was also associated with transfusions (p < 0.001). Volume of transfusion was only modestly correlated with BL (Spearman r = 0.49). BL was not significantly associated with patient outcomes. However, transfusions were associated with lower recurrence-free and cancer-specific survival probabilities (both, p < 0.001), which was independent of clinical stage (both, p = 0.001). CONCLUSIONS Patients with advanced clinical stage experience greater BL during cystectomy, which may impact time under anesthesia and transfusions. Patient performance, pre-op labs, and operative factors also influence transfusions. While BL does not appear to affect prognosis after radical cystectomy, this analysis indicates that transfusions may impact oncological outcomes. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e211-e212 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anirban P Mitra Los Angeles, CA More articles by this author Eila C. Skinner Stanford, CA More articles by this author Anne K. Schuckman Los Angeles, CA More articles by this author Gus Miranda Los Angeles, CA More articles by this author Siamak Daneshmand Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...