Are Allogeneic Blood Transfusions Associated With Decreased Survival After Surgery for Long-bone Metastatic Fractures?

Abstract

Background Previous studies have shown that perioperative blood transfusion increases cancer recurrence and decreases patient survival after resection of primary malignancies. The question arises whether this association also exists in patients with already disseminated disease undergoing surgery for metastatic long-bone fractures. Purposes We sought to determine whether perioperative allogeneic blood transfusion is associated with decreased survival after operative treatment of long-bone metastatic fractures after accounting for clinical, laboratory, and treatment factors. Secondarily, we aimed to identify potential factors that are associated with decreased survival. Methods We included 789 patients in our retrospective study who underwent surgery at two institutions for a pathologic or impending metastatic long-bone fracture. We used multivariable Cox proportional hazards regression model analysis to assess the relationship of perioperative allogeneic blood transfusion with survival, and accounted for patient age, sex, comorbidities, BMI, tumor type, fracture type and location, presence of other bone and visceral metastases, previous radiotherapy and systemic therapy, preoperative embolization, preoperative hemoglobin level, treatment type, anesthesia time, blood loss, duration of hospital admission, year of surgery, and hospital. Results Considering transfusion as an ''exposure,'' and comparing patients who received transfusions with those who did not, we found that blood transfusion was not associated with decreased survival after accounting for all explanatory variables (hazard ratio [HR] 1.06; 95% CI, 0.87-1.30; p = 0.57). Evaluating transfusion in terms of dose-response, we found that patients who received more transfusions had lower survival compared with those who had fewer transfusions after accounting for all explanatory variables (HR per unit of blood transfused, 1.07; 95% CI, 1.02-1.12; p = 0.005). We found that age (HR, 1.02; 95%

Hypoalbuminemia as an Independent Risk Factor for Perioperative Complications Following Surgical Decompression of Spinal Metastases

“…1,20,[41][42][43] Minimizing blood loss and perioperative transfusions not only reduces health care costs 14,15,44,45 but may also play a role in reducing perioperative mortality. [46][47][48][49][50] Perioperative transfusion of allogeneic blood has also been associated with higher infection rates following various orthopedic procedures, 48,[51][52][53][54][55] and in this study, 48.6% of patients with perioperative sepsis had received a perioperative blood transfusion. Therefore, our results support optimization of albumin levels preoperatively in order to minimize perioperative transfusions and their associated complications.…”

Continued decline in blood collection and transfusion in the United States–2015

“…Recent studies also have described an association between liberal transfusion policies and increased incidence of health care‐associated infections, including surgical site infections and sepsis . Other studies have implicated high PLT dosing as a risk factor for transfusion‐associated adverse events, and transfusions in patients with certain gastrointestinal and other metastatic diseases may be associated with reduced chances of remission and survival . It is possible that clinical recommendations supported by these studies have motivated the decreased demand for blood products.…”

“…30,31 Other studies have implicated high PLT dosing as a risk factor for transfusion-associated adverse events, 32,33 and transfusions in patients with certain gastrointestinal and other metastatic diseases may be associated with reduced chances of remission and survival. [34][35][36][37] It is possible that clinical recommendations supported by these studies have motivated the decreased demand for blood products. Currently, the risk of transfusion-transmitted infections in the United States blood supply is very low.…”

Body composition predictors of mortality in patients undergoing surgery for long bone metastases

“…Due to the incurable nature of metastatic disease, treatment for these patients is primarily performed for palliative measures to maintain or optimize quality of life. For some patients, the benefits of surgery may not outweigh the disadvantages that come with it such as perioperative mortality, postoperative complications, hospitalization, and reoperations 3,4 . Less intensive treatment, such as radiation therapy or minimally invasive stabilization, might be more appropriate for patients with an estimated short survival.…”