Association between Intraoperative Blood Transfusion and Mortality and Morbidity in Patients Undergoing Noncardiac Surgery

Lamb

et al. 2017

European Urology Focus

In-depth critical analysis of complications following robot-assisted radical cystectomy with intracorporeal urinary diversion. European Urology Focus, (doi:10.1016Focus, (doi:10. /j.euf.2016 This is the author's final accepted version.There may be differences between this version and the published version. You are advised to consult the publisher's version if you wish to cite from it.http://eprints.gla.ac.uk/145598/ RESULTS AND LIMITATIONSThe 90-day all complication rate following ileal conduit and continent diversion was 68% and 82.4% while major complications were 21.0% and 20.6% respectively. 90-day mortality was 3% and 2.9% for ileal conduit and continent diversion patients respectively. On multivariate analysis, blood transfusion requirement was independently associated with major (p=0.002) and all 30-day (p=0.002) and 90-day major complications (p=0.012) while male patients were associated with 90-day major complications (p=0.015). Critical analysis identified surgical complications was responsible for 39.4% of all 90-day major complications. PATIENT SUMMARYIn this report, we looked at the surgical outcomes in bladder cancer patients treated with minimal invasive robotic surgery. We found that surgical complications account for most major complications and previous surgical experience may be a confounding factor when interpreting results from different center even in a randomised trial setting.

Section: Discussionsupporting

confidence: 81%

In-depth Critical Analysis of Complications Following Robot-assisted Radical Cystectomy with Intracorporeal Urinary Diversion

Lamb

et al. 2017

European Urology Focus

“…10 Additional benefits of the NSQIP database are that data are collected in a standardized manner at each site with strict variable definitions and annual quality checks 10 and the database has been validated for accuracy and reproducibility and achieves a >95% 30-day outcome follow-up rate across consecutive cycles. 10,26 In conclusion, to our knowledge, this is the first prospective, multi-institutional study to assess the relation between age, other preoperative and perioperative risk factors, and short-term outcomes after craniotomy for definitive tumor resection in the elderly (aged !75 years) compared with younger adults. Advanced age (!75 years) was not correlated with poorer short-term outcomes.…”

Section: Limitationsmentioning

confidence: 94%

Short‐term outcomes of craniotomy for malignant brain tumors in the elderly

Seicean

Schiltz

et al. 2012

Cancer

BACKGROUND. Disparity in resection rates for malignant brain tumors in elderly patients is partially attributed to a belief that advanced age is associated with an increased risk of postoperative morbidity and mortality. The objective of this study was to investigate the effect of advanced age (!75 years) on 30-day outcomes in patients with primary and metastatic brain tumors who underwent craniotomy for definitive resection of a malignant brain tumor. METHODS. The authors conducted prospective analyses of the American College of Surgeons' National Surgical Quality-Improvement Project (NSQIP) database from 2006 to 2010 of 970 patients aged !40 years who underwent craniotomy for definitive resection of neoplasm. Preoperative and intraoperative characteristics and 30-day outcomes were stratified by age. By using propensity scores, 134 patients (aged !75 years) were matched to 134 patients ages 40 to 74 years. Logistic regression was used to predict adverse postoperative outcomes. RESULTS. The median length of hospital stay was 5 days; the rate of minor and major complications were 5.9% and 13.1%, respectively; 5.7% of patients returned to the operating room; and 4.3% of patients died within 30 days. Advanced age did not increase the odds for poorer short-term outcomes. CONCLUSIONS. Advanced age did not increase the risk of poor outcomes after surgical resection of primary or metastatic intracranial tumors when analyses were controlled for other risk factors. These results suggest that age should not be used, in isolation, as an a priori factor to discourage pursuing craniotomy.

American Journal of Obstetrics and Gynecology

“…8 Blood transfusions are also correlated with adverse postoperative outcomes and their associated costs, including septic, wound, thromboembolic, and pulmonary complications; longer hospital stays; higher hospital charges; and patient death. [9][10][11] The average risk of transfusion is variable in gynecology and ranges from 0.01% for operative hysteroscopy, 2-5% for operative laparoscopy, 0.3-11% for hysterectomy, 21% for myomectomy, and up to 78% for cytoreductive surgery. [12][13][14][15][16][17][18] However, the overall average risk of a woman requiring a blood transfusion after gynecologic surgery is low making routine testing a high-cost, low-value decision.…”

Section: Introductionmentioning

confidence: 99%

A model to predict risk of blood transfusion after gynecologic surgery

Stanhiser

Chagin

Jelovsek

2017

BACKGROUND:A model that predicts a patient's risk of receiving a blood transfusion may facilitate selective preoperative testing and more efficient perioperative blood management utilization. OBJECTIVE: We sought to construct and validate a model that predicts a patient's risk of receiving a blood transfusion after gynecologic surgery. STUDY DESIGN: In all, 18,319 women who underwent gynecologic surgery at 10 institutions in a single health system by 116 surgeons from January 2010 through June 2014 were analyzed. The data set was split into a model training cohort of 12,219 surgeries performed from January 2010 through December 2012 and a separate validation cohort of 6100 surgeries performed from January 2013 through June 2014. In all, 47 candidate risk factors for transfusion were collected. Multiple logistic models were fit onto the training cohort to predict transfusion within 30 days of surgery. Variables were removed using stepwise backward reduction to find the best parsimonious model. Model discrimination was measured using the concordance index. The model was internally validated using 1000 bootstrapped samples and temporally validated by testing the model's performance in the validation cohort. Calibration and decision curves were plotted to inform clinicians about the accuracy of predicted probabilities and whether the model adds clinical benefit when making decisions. RESULTS: The transfusion rate in the training cohort was 2% (95% confidence interval, 1.72e2.22). The model had excellent discrimination and calibration during internal validation (bias-corrected concordance index, 0.906; 95% confidence interval, 0.890e0.928) and maintained accuracy during temporal validation using the separate validation cohort (concordance index, 0.915; 95% confidence interval, 0.872e0.954). Calibration curves demonstrated the model was accurate up to 40% then it began to overpredict risk. The model provides superior net benefit when clinical decision thresholds are between 0-50% predicted risk. CONCLUSION: This model accurately predicts a patient's risk of transfusion after gynecologic surgery facilitating selective preoperative testing and more efficient perioperative blood management utilization.