MP67-10 INCREASED INFECTIOUS COMPLICATIONS IN TRANSFUSED PATIENTS AFTER RADICAL CYSTECTOMY FOR BLADDER CANCER

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive IV1 Apr 2015MP67-10 INCREASED INFECTIOUS COMPLICATIONS IN TRANSFUSED PATIENTS AFTER RADICAL CYSTECTOMY FOR BLADDER CANCER Jen-Jane Liu, Bryan Maxwell, Max Kates, Hiten Patel, Gregory Joice, Nilay Gandhi, Charles Drake, Steve Frank, and Trinity Bivalacqua Jen-Jane LiuJen-Jane Liu More articles by this author , Bryan MaxwellBryan Maxwell More articles by this author , Max KatesMax Kates More articles by this author , Hiten PatelHiten Patel More articles by this author , Gregory JoiceGregory Joice More articles by this author , Nilay GandhiNilay Gandhi More articles by this author , Charles DrakeCharles Drake More articles by this author , Steve FrankSteve Frank More articles by this author , and Trinity BivalacquaTrinity Bivalacqua More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2493AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Infectious complications are the most common morbidity after radical cystectomy (RC), and a growing body of evidence suggests that allogeneic blood transfusions (ABT) may have an immunosuppressive effect. While it has been recognized that ABTs may confer an increased risk of adverse oncologic outcomes after RC, no large analyses have assessed whether ABTs increase the risk of perioperative infection. METHODS We used the Nationwide Inpatient Sample (1998 to 2011) to study the use of ABT during RC for urothelial carcinoma and identify infectious complications, including superficial or deep wound infection, urinary tract infection, postoperative pneumonia, and sepsis. We examined the association between ABT and any infectious complications and performed a multivariate analysis to control for the effect of age, year of surgery, obesity, chronic kidney disease, Elixhauser comorbidity score, and type of urinary diversion. RESULTS We reviewed records reflective of an estimated 126,454 RCs performed nationwide during the study period. Of these, 34,203 (27.0%) received an ABT. The use of ABT increased over the study period, from 18.4% in 1998 to 31.6% in 2011 (p for trend <0.0001, Figure 1). Patients who received an ABT had an increased risk of perioperative infectious complications [36.7% vs 27.7%, unadjusted OR (95% CI) =1.51 (1.43-1.60), p<0.0001]. After adjusting for potential confounders, ABT remained an independent predictor of infectious complications [adjusted OR (95% CI) = 1.46 (1.38-1.55), p<0.0001]. CONCLUSIONS This analysis provides strong observational evidence that ABTs are associated with an increased risk of perioperative infectious complications, which may be due to transfusion-related immunomodulation. Avoidance of these complications is additional cause to aggressively pursue blood conservation strategies and use evidence-based “restrictive” transfusion thresholds. Further analysis is needed to explore whether additional interventions (e.g. expanded perioperative antibiotic prophylaxis) are effective in reducing the incidence and severity of perioperative infectious complications in patients who experience significant bleeding and require a transfusion despite measures to avoid them. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e853-e854 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jen-Jane Liu More articles by this author Bryan Maxwell More articles by this author Max Kates More articles by this author Hiten Patel More articles by this author Gregory Joice More articles by this author Nilay Gandhi More articles by this author Charles Drake More articles by this author Steve Frank More articles by this author Trinity Bivalacqua More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...