Receipt Of Perioperative Blood Transfusion Research Articles

Intraoperative but not postoperative blood transfusion adversely affect cancer recurrence and survival following nephrectomy for renal cell carcinoma

The association between perioperative blood transfusion (PBT) with adverse oncological outcomes have been previously reported in multiple malignancies including RCC. Nevertheless, the importance of transfusion timing is still unclear. The primary purpose of this study is to appraise whether the receipt of intraoperative blood transfusion (BT) differ from postoperative BT in regards to cancer outcomes in renal cell carcinoma (RCC) patients treated with nephrectomy. Data on 1168 patients with RCC, who underwent radical or partial nephrectomy as primary therapy between 1988–2013 were analyzed. PBT was defined as transfusion of allogeneic red blood cells (RBC) during surgery or the postsurgical period. Survival was analyzed and compared using the Kaplan–Meier method with the log-rank test. Of 1168 patients, 198 patients (16.9%) received a PBT. Including 117 intraoperative BT and 81 postoperative BT. Only 21 (10.6%) patients required both intraoperative and postoperative BT. On multivariate analyses, receipt of PBT was associated with significantly worse local disease recurrence (HR: 2.4; P = 0.017), metastatic progression (HR: 2.7; P = 0.005), cancer-specific mortality (HR: 3.5; P = 0.002) and all-cause mortality (HR: 2.1; P = 0.005). Nevertheless, postoperative BT was not independently associated with increased risk of local recurrence (p = 0.1), metastatic progression (P = 0.16) or kidney cancer death (P = 0.63), yet did significantly increase the risk of overall mortality (HR: 2.6; P = 0.004). In the current study, intraoperative transfusion of allogeneic RBC is associated with increased risks of cancer recurrence and mortality following nephrectomy.

Post-Operative Infections among Patients Undergoing Radical Cystectomy at a Tertiary Center.

Post-operative infection after radical cystectomy is a common complication. It is essential to identify modifiable risk factors that can predict post-operative infection to reduce the incidence of infection after radical cystectomy. We investigated the incidence of post-operative infection, associated pathogens, and risk factors for post-operative infection after radical cystectomy. Patients who underwent radical cystectomy for bladder cancer in a single urologic department from 2014 to 2016 were included. Age, gender, length of stay, body mass index (BMI), diabetes mellitus, hypertension, pre-operative estimated glomerular filtration rate, hydronephrosis, smoking status, neoadjuvant chemotherapy, pathologic tumor stage, pathologic nodal stage, types of urinary diversion, laparoscopic approach, operative time, and receipt of peri-operative blood transfusion were assessed to determine the association of these factors with the risk of infection within 30 days of radical cystectomy. Risk factors were assessed for correlation with any kind of infection and separately for urinary tract infection (UTI), blood infection/septic shock (BI), and surgical site infection (SSI). Pathogens were identified in all cases of infection. A total of 134 patients were included in the analysis. Post-operative infection was diagnosed in 10.45%. Urinary tract infection, BI, and SSI were diagnosed in 3.73%, 4.48%, and 7.46%, respectively. Co-infections and mixed infection were diagnosed in 50% of patients with infection. Enterococcus was the most common pathogen. On multivariable analysis, age, BMI ≥30 kg/m2, and laparoscopic approach were associated with the risk of infection; odds ratios (ORs) were 1.27 (95% confidence interval [CI] 1.01-1.59), 13.07 (1.39-122.88), and 0.07 (0.01-0.78), respectively. One-tenth of patients undergoing radical cystectomy developed an infection within 30 days of surgery. Fifty percent of patients had co-infection with UTI, SSI, and/or BI and 50% of infections were polymicrobial. Increased BMI is the strongest factor associated independently with all types of infection. Therefore, obese patients should be encouraged to lose weight pre-operatively.

Surgical Site Infections in Emergency Abdominal Surgery at Tamale Teaching Hospital, Ghana.

Surgical site infections (SSIs) result in delayed wound healing, increased use of antibiotics and increased length of hospital stay, putting remarkable physical and financial burden on patients, their relatives and the healthcare facilities. Patient-related factors, such as pre-existing colonization with antibiotic-resistant bacteria, and clinical-related factors, such as adherence to sterile techniques, contribute to the development of SSIs. The objective of this study, therefore, was to determine the SSI rate and risk factors for emergency abdominal surgeries at Tamale Teaching Hospital, Ghana. The study population was composed of patients undergoing emergency abdominal surgery at the Tamale Teaching Hospital between June 2010 and June 2015. Demographic and clinical data were collected and included, but was not limited to, patient age and sex, type of procedure performed, wound class (dirty or contaminated), receipt of perioperative blood transfusion, American Society of Anesthesiologists (ASA) score, presence of SSI, length of hospital stay and outcome of surgery. Standard multiple regression was used to statistically assess the independent variables for their association with SSI, and Pearson correlation coefficient was used to determine the strength of association. The beta (β) values, which had the greatest influence on the overall SSI, indicated the relative influence of the entered variable(s). A total of 1011 patients underwent various emergency abdominal surgical procedures during the period of study. The β values were 0.008 for perioperative blood transfusion, 0.050 for sex, -0.048 for ASA risk, -0.001 for having health insurance, 0.037 for being referred from another health facility and 0.034 for age. Sex was the most distinctive contributor to SSI, while perioperative blood transfusion showed the least influence. Sex and ASA score were the best predictors of SSI occurrence. The coefficients of the P values for wound class and serum haemoglobin level (g/dL) were 0.000 and 0.032, respectively. The outcome of surgery was significantly and strongly associated with overall SSI and vice versa (r=0.088, P<0.01 two-tailed). Sex, ASA score, perioperative blood transfusion, wound class and haemoglobin level can predispose to SSI.

Perioperative Allogenic Blood Transfusion in Renal Cell Carcinoma: Risk Factors and Effect on Long-term Outcomes.

We sought to create a preoperative model to predict the risk of perioperative blood transfusion (PBT) in patients with renal cell carcinoma (RCC) undergoing nephrectomy and to evaluate the effect of PBT on long-term outcomes. The present retrospective study included 648 consecutive patients who had undergone radical or partial nephrectomy for RCC at a single institution. The risk factors for PBT were analyzed using logistic regression analysis. Cox proportional hazards models addressed the effect of PBT on overall and RCC-specific mortality. A total of 62 patients (10%) received a median of 2 red blood cell units (interquartile range, 2-3; range 1-20). On multivariable logistic regression analysis, 2 preoperative factors were independently associated with receipt of PBT: preoperative anemia (odds ratio, 6.28; P< .001) and open surgery (odds ratio, 3.40; P< .001). The risk of receiving PBT was high with both risk factors present (34%), intermediate with 1 risk factor present (7%-12%), and low with 0 risk factors present (2%). Within a median follow-up period of 63 months (interquartile range, 32-91), 108 patients (17%) had died of RCC and 177 (27%) had died of any cause. In the multivariable Cox models, PBT remained independently associated with overall mortality (hazard ratio [HR], 1.86; P= .004) and RCC-specific mortality (HR, 1.79; P= .007). A dose-dependent association of PBT with RCC-specific mortality was observed (HR, 1.14; P= .01). In patients undergoing surgery for RCC, PBT was associated with adverse overall and RCC-specific mortality. Patients with preoperative anemia and those scheduled to undergo open surgery are at an increased risk of PBT and could be candidates for perioperative optimization techniques.

A Critical Analysis of Perioperative Outcomes in Morbidly Obese Patients Following Renal Mass Surgery

To evaluate if body mass index (BMI) ≥ 40 is associated with risk of postoperative complications, receipt of perioperative blood transfusion (PBT), length of hospital stay (LOS), perioperative death, or hospital readmission rate following renal mass surgery. After Institutional Review Board approval, comprehensive information was collected for patients treated with surgery for renal mass from 2000 to 2015 at one institution. Univariable and multivariable analyses were used to evaluate the association of BMI ≥ 40 among other putative risk factors for perioperative outcomes. A total of 1048 patients were treated surgically, including 115 (11%) with BMI > 40. Minimally invasive and open surgical approaches were used for 480 (45.8%) and 568 (54.2%) patients, respectively. Morbid obesity was not associated with risk of major complications, overall complications, receipt of PBT, LOS, hospital readmission rate, or perioperative death. Charlson comorbidity index was the only independent predictor of major complications following renal mass surgery, P = .0006, per point odds ratio 1.2 (95%C.I. 1.08-1.32). Surgical site infections (SSIs) were more common in patients with BMI ≥ 40 vs BMI < 40 (10.5% vs 4.8%, P = .01). Following multivariable analysis, BMI ≥ 40 was the only independent predictor of SSIs, odds ratio 2.6, 95% confidence interval 1.32-5.13; P = .006. Morbid obesity (BMI ≥ 40) is an independent predictor of developing SSIs following renal mass surgery. Morbid obesity is not predictive of risk for major complications, receipt of PBT, hospital readmission, perioperative death, or LOS.

MP64-09 DECREASE IN LONG-TERM DISEASE-SPECIFIC SURVIVAL WITH PERIOPERATIVE BLOOD TRANSFUSION FOLLOWING RADICAL CYSTECTOMY

You have accessJournal of UrologyBladder Cancer: Natural History and Pathophysiology1 Apr 2015MP64-09 DECREASE IN LONG-TERM DISEASE-SPECIFIC SURVIVAL WITH PERIOPERATIVE BLOOD TRANSFUSION FOLLOWING RADICAL CYSTECTOMY Bethany K. Burge, Robert H. Blackwell, Evan Carlos, Robert C. Flanigan, Gopal N. Gupta, and Marcus L. Quek Bethany K. BurgeBethany K. Burge More articles by this author , Robert H. BlackwellRobert H. Blackwell More articles by this author , Evan CarlosEvan Carlos More articles by this author , Robert C. FlaniganRobert C. Flanigan More articles by this author , Gopal N. GuptaGopal N. Gupta More articles by this author , and Marcus L. QuekMarcus L. Quek More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2320AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical cystectomy (RC) is a morbid procedure, which can be associated with substantial blood loss and need for perioperative blood transfusion (PBT). PBT has been associated with a decrease in disease-specific survival for patients undergoing surgery for other malignancies. We hypothesize that receipt of PBT may have an immunosuppressive effect that can impact the natural course of bladder cancer after definitive surgical treatment. We evaluate the effects of blood transfusion on overall (OS), disease-specific (DSS), and recurrence-free survival(RFS)in patients who underwent RC for bladder carcinoma. METHODS A retrospective review was performed of 521 patients who underwent RC at Loyola University Medical Center from 1996 to 2014. Patients were categorized into two cohorts; those who did and did not receive PBT. Student's T-test was used to assess continuous variables, and Pearson's Chi-squared test to assess categorical variables. The effect of PBT on OS, DSS, and RFS were estimated using the Kaplan-Meier method and compared with the log-rank test. RESULTS Blood transfusion data was available for 487 patients (93.5%), with an overall mean follow up of 30 months. Of these patients, 243 (49.8%) received PBT. Cohorts were well-matched with regards to cancer-specific variables, with no differences between pathologic tumor stage, nodal stage, presence of lymphovascular invasion, primary histology, or presence of positive margins. PBT patients were older than control patients (mean age 69.1 vs 66.7, p<0.05). DSS and OS were found to be significantly decreased in PBT patients compared to controls, at median 77.8 months vs. 111.1 months (p=0.002) and 54.5 months vs. 80.3 months (p=0.002), respectively. Figures A and B. RFS approaches significance favoring improved freedom from recurrence in control patients, at median 64.4 months vs. 100.4 months respectively (p=0.059). CONCLUSIONS RC patients who received PBT had a decreased OS and DSS. Coupled with a trend toward a higher rate of cancer recurrence in the PBT group, these results suggest that receipt of blood products may have an immunosuppressive effect that impairs the body's ability to fight microscopic residual disease, contributing to poorer survival in this cohort. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e801 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bethany K. Burge More articles by this author Robert H. Blackwell More articles by this author Evan Carlos More articles by this author Robert C. Flanigan More articles by this author Gopal N. Gupta More articles by this author Marcus L. Quek More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The prognostic impact of perioperative blood transfusion on survival in patients with bladder urothelial carcinoma treated with radical cystectomy.

PurposeThe aim of our study was to assess the influence of perioperative blood transfusion (PBT) on survival outcomes following radical cystectomy (RC) and pelvic lymph node dissection (PLND).Materials and MethodsWe reviewed and analyzed the clinical data of 432 patients who underwent RC for bladder cancer from 1991 to 2012. PBT was defined as the transfusion of allogeneic red blood cells during RC or postoperative hospitalization.ResultsOf all patients, 315 patients (72.9%) received PBT. On multivariate logistic regression analysis, female gender (p=0.015), a lower preoperative hemoglobin level (p=0.003), estimated blood loss>800 mL (p<0.001), and performance of neoadjuvant chemotherapy (p<0.001) were independent risk factors related to requiring perioperative transfusions. The receipt of PBT was associated with increased overall mortality (hazard ratio, 1.91; 95% confidence interval, 1.25-2.94; p=0.003) on univariate analysis, but its association was not confirmed by multivariate analysis (p=0.058). In transfused patients, a transfusion of >4 packed red blood cell units was an independent predictor of overall survival (p=0.007), but not in cancer specific survival.ConclusionsOur study was not conclusive to detect a clear association between PBT and survival after RC. However, the efforts should be made to continue limiting the overuse of transfusion especially in patients who are expected to have a high probability of PBT, such as females and those with a low preoperative hemoglobin level and history of neoadjuvant chemotherapy.

The Impact of Perioperative Blood Transfusion on Cancer Recurrence and Survival Following Radical Cystectomy

BackgroundWhile the receipt of a perioperative blood transfusion (PBT) has been associated with an increased risk of mortality for a number of malignancies, the relationship between PBT and survival following radical cystectomy (RC) for bladder cancer (BCa) has not been well established. ObjectiveTo evaluate the association of PBT with disease recurrence and mortality following RC. Design, setting, and participantsWe identified 2060 patients who underwent RC at the Mayo Clinic between 1980 and 2005. PBT was defined as transfusion of allogenic red blood cells during RC or postoperative hospitalization. Outcome measurements and statistical analysisSurvival was estimated using the Kaplan-Meier method and was compared with the log-rank test. Cox proportional hazard regression models were used to evaluate the association of PBT with outcome, controlling for clinicopathologic variables. Results and limitationsA total of 1279 patients (62%) received PBT. The median number of units transfused was 2 (interquartile range [IQR]: 2–4). Patients receiving PBT were significantly older (median: 69 yr vs 66 yr; p<0.0001), had a worse Eastern Cooperative Oncology Group performance status (p<0.0001), and were more likely to have muscle-invasive tumors (56% vs 49%; p=0.004). Median postoperative follow-up was 10.9 yr (IQR: 7.9–15.7). Receipt of PBT was associated with significantly worse 5-yr recurrence-free survival (58% vs 64%; p=0.01), cancer-specific survival (59% vs 72%; p<0.001), and overall survival (45% vs 63%; p<0.001). On multivariate analyses, PBT remained associated with significantly increased risks of postoperative tumor recurrence (hazard ratio [HR]: 1.20; p=0.04), death from BCa (HR: 1.31; p=0.003), and all-cause mortality (HR: 1.27; p=0.0002). Among patients who received PBT, an increasing number of units transfused was independently associated with increased cancer-specific mortality (HR: 1.07; p<0.0001) and all-cause mortality (HR: 1.05; p<0.0001). Limitations include selection bias and lack of standardized transfusion criteria. ConclusionsWe found that PBT is associated with significantly increased risks of cancer recurrence and mortality following RC. While external validation is required, continued efforts to reduce the use of blood products in these patients are warranted.