Improved postoperative outcomes and reduced transfusion rates after implementation of a Patient Blood Management program in gastric cancer surgery

Abstract

IntroductionGastric cancer patients are often transfused with red blood cells, with negative impact on postoperative course. This multicenter prospective interventional cohort study aimed to determine whether implementation of a Patient Blood Management (PBM) program, was associated with a decrease in transfusion rate and improvements in clinical outcomes in gastric cancer surgery. MethodsWe compared transfusion practices and clinical outcomes in patients undergoing elective gastric cancer resection before and after implementing a PBM program, including strategies to detect and treat anemia and restrictive transfusion practice (2014–2018). Primary outcome was transfusion rate (TR). Secondary outcomes were complications, reoperations, length of stay, readmissions, 90-day mortality and failure-to-rescue. Differences were adjusted by confounding factors. ResultsSome 789 patients were included (496 pre- and 293 post-PBM). TR decreased from 39.1% to 27.0% (adjusted difference −9.1, 95% CI -15.2 to −2.9), being reduction particularly significant in patients with anemia, ASA score 3–4, locally advanced tumors, undergoing open surgery and total gastrectomy. Infectious complications diminished from 25% to 16.4% (−6.1, 95%CI -11.5 to −0.7), reoperations from 8.1% to 6.1% (−2.2, 95%CI -5.1 to +0.6), median length of stay from 11 [IQR 8–18] to 8 [7–12] days (p < 0.001), hospital readmission from 14.1% to 8.9% (−5.4, 95%CI -9.6 to −1.1), mortality from 7.9% to 4.8% (−2.4, 95%CI -4.7 to −0.01), and failure-to rescue from 62.7% to 32.7% (−23.1, 95%CI -37.7 to −8.5). ConclusionImplementation of a PBM program was associated with a reduction in transfusion rate and improvement in postoperative outcomes in gastric cancer patients undergoing curative resection.