MP63-15 VALIDATION OF PERI-OPERATIVE BLOOD TRANSFUSION AS A SURGICAL QUALITY INDICATOR OF CYSTECTOMY: A POPULATION-BASED STUDY

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive V1 Apr 2016MP63-15 VALIDATION OF PERI-OPERATIVE BLOOD TRANSFUSION AS A SURGICAL QUALITY INDICATOR OF CYSTECTOMY: A POPULATION-BASED STUDY D. Robert Siemens, Melanie Jaeger, Xuejiao Wei, Francisco Vera-Badillo, and Christopher Booth D. Robert SiemensD. Robert Siemens More articles by this author , Melanie JaegerMelanie Jaeger More articles by this author , Xuejiao WeiXuejiao Wei More articles by this author , Francisco Vera-BadilloFrancisco Vera-Badillo More articles by this author , and Christopher BoothChristopher Booth More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.944AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previous single-center studies of peri-operative blood transfusion (PBT) at the time of radical cystectomy have suggested a potential association with long-term cancer survival. Here we describe the frequency of PBT at cystectomy in routine clinical practice and evaluate its effect on outcomes in order to explore its utility as a quality indicator of surgical care. METHODS Electronic records of treatment and surgical pathology reports were linked to the population-based Ontario Cancer Registry to identify all patients with bladder cancer who underwent cystectomy and PBT between 2000-2008. Hospital discharge records identified PBT. Modified Poisson regression model was used to determine the factors associated with PBT. A Cox proportional hazards regression model was used to explore the association between PBT and overall (OS) and cancer-specific (CSS) survival. RESULTS Among the 2593 patients with cystectomy in 2000-2008, 62% received an allogenic red blood cell transfusion. The frequency of PBT decreased over the study period (from 68% in 2000 to 54% in 2008, p<0.001). Factors associated with receiving PBT included age (80+ years RR 1.25, 95%CI 1.14-1.39), sex (female RR 1.40, 95%CI 1.33-1.48), greater co-morbidity (RR 1.11, 95%CI 1.03-1.20), T stage (T4 tumor RR 1.24, 95%CI 1.12-1.36) and surgeon volume (lowest quartile RR 1.18, 95%CI 1.08-1.28). Utilization of PBT was associated with inferior early outcomes including median length of stay (11 days vs 9 days, p<0.001), 90-day readmission rate (38% vs 29%, p<0.001) and 90-day mortality (11% vs 4%, p<0.001). OS (32% vs 47%, p<0.001) and CSS (38% vs 54%, p<0.001) at five years were lower among patients with PBT. These differences in long-term survival persisted on multivariate analysis (OS HR 1.33,95% CI 1.20-1.48; CSS HR 1.39, 95% CI 1.23-1.56). CONCLUSIONS Although rates are decreasing, these data suggest very high utilization rate of PBT at time of cystectomy in routine clinical practice. PBT is associated with substantially lower long-term survival. This association persists despite adjustment for provider volume, suggesting that PBT is a valid indicator of surgical care of bladder cancer. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e827 Advertisement Copyright & Permissions© 2016MetricsAuthor Information D. Robert Siemens More articles by this author Melanie Jaeger More articles by this author Xuejiao Wei More articles by this author Francisco Vera-Badillo More articles by this author Christopher Booth More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...