Predictive factors for perioperative blood transfusions in partial nephrectomy for renal masses

Abu-Ghanem, Yasmin; Dotan, Zohar; Kaver, Issac; Ramon, Jacob

doi:10.1002/jso.24029

Cited by 7 publications

(3 citation statements)

References 38 publications

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“…Of these observed differences between PBT and non-PBT patients, the presence of a preoperatively impaired renal function was, in addition to PS, tumor stage, distant metastases, and anemia, an independent risk factor to obtain a PBT in the multivariable analysis (HR 2.55, 95% CI 1.46–4.45, p = 0.001). Other authors found that the odds of a PBT was associated with age, gender, PS, tumor stage and localization, surgical volume and experience, open surgery, a preoperative anemia, and cumulative comorbidity scores, but they did not investigate the relationship between a preoperative CKD alone with the risk of applying a PBT [3, 11, 12]. Therefore, our study is the first that reveals patients with a CKD are a priori at risk to obtain a PBT, which represents the first link between a PBT and renal function in our study.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Blood Transfusion Is a Predictor of Acute and Chronic Renal Function Deterioration after Partial and Radical Nephrectomy for Renal Cell Carcinoma

et al. 2020

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Introduction: The aim was to evaluate the impact of perioperative blood transfusions (PBTs) on renal function after surgery for renal cell carcinoma (RCC). Methods: Consecutive patients with RCC who underwent partial nephrectomy or radical nephrectomy between 2005 and 2015 at a tertiary care center were included. Minimum follow-up period was 6 months. A PBT was defined as the transfusion of packed erythrocyte concentrate (EC) within 7 days before until 30 days after surgery. The multivariable analyses were carried out by Cox regression. Results: The overall cohort included 851 patients, of whom 93 (10.9%) received a PBT. The median follow-up was 46 months (range 28-72). In case of a PBT, a median of 2 EC was transfused. PBT patients were older and had a poorer performance status and more comorbidities as well as locally more advanced or metastatic tumors. In the multivariable analyses, PBT was an independent prognostic factor for acute as well as chronic renal impairment (hazard ratio (HR) 2.72, 95% confidence interval (95% CI) 1.45-5.10, p = 0.002 and HR 2.23, 95% CI 1.26-3.70, p = 0.007). Conclusion: PBT is associated with acute and chronic deterioration of kidney function after surgery for RCC. Thus, it may be used to identify patients requiring close nephrological monitoring.

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Section: Discussionmentioning

confidence: 99%

Perioperative Blood Transfusion Is a Predictor of Acute and Chronic Renal Function Deterioration after Partial and Radical Nephrectomy for Renal Cell Carcinoma

et al. 2020

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“…Several risk factors for hemorrhage during nephrectomy have been documented, including patient age, high Charlson score, low preoperative hemoglobin level, bigger lesion size, central renal lesions and surgeon/ hospital volume quartile. 39,40 Simultaneously, inconsistent results have been reported regarding the association of PBT with RCC recurrence and CSS after nephrectomy ( Table 2). While Moffat and colleagues 41 did not detect a significant difference in CSS, Manyonda and colleagues 42 and Mermershtain and colleagues 43 noted that the 5-year CSS was significantly lower in patients who received PBT during PN or RN.…”

Section: Bladder Cancermentioning

confidence: 99%

Impact of perioperative blood transfusions on clinical outcomes in patients undergoing surgery for major urologic malignancies

Abu-Ghanem

Ramon

2019

Therapeutic Advances in Urology

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The association between allogeneic perioperative blood transfusion (PBT) and decreased survival among patients undergoing various oncological surgeries has been established in various malignant diseases, including colorectal, thoracic and hepatocellular cancer. However, when focusing on urologic tumors, the significance of PBT and its adverse effect remains debatable, mainly due to inconsistency between studies. Nevertheless, the rate of PBT remains high and may reach up to 62% in patients undergoing major urologic surgeries. Hence, the relatively high rate of PBT among related operations, along with the increasing prevalence of several urologic tumors, give this topic great significance in clinical practice. Indeed, recent retrospective studies, followed by systematic reviews in both prostate and bladder cancer surgery have supported the association that has been demonstrated in several malignancies, while other major urologic malignancies, including renal cell carcinoma and upper tract urothelial carcinoma, have also been addressed retrospectively. It is only a matter of time before the data will be sufficient for qualitative systematic review/qualitative evidence synthesis. In the current study, we performed a literature review to define the association between PBT and the oncological outcomes in patients who undergo surgery for major urologic malignancies. We believe that the current review of the literature will increase awareness of the importance and relevance of this issue, as well as highlight the need for evidence-based standards for blood transfusion as well as more controlled transfusion thresholds.

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“…A significant association between allogeneic blood transfusion and preoperative anaemia or low preoperative Hb has been reported in multiple studies and across different surgical disciplines (Rosencher et al, ; Saxena et al, ; Takami & Masumoto, ; Mathews et al, ; Browne et al, ; Ogbemudia et al, ; Perisanidis et al, ; Abu‐Ghanem et al, ; Abu‐Ghanem et al, ; Wong et al, ), and notably, a preoperative Hb <120 g L −1 has been associated with a 10‐fold increase in the requirement for allogeneic blood transfusion following total hip and knee joint arthroplasty (Ogbemudia et al, ). To address preoperative anaemia, clinical practice guidelines published by National Institute for Health and Care Excellence (NICE), the British Committee for Standards in Haematology, the Association of Anaesthetists of Great Britain and Ireland and the Network for Advancement of Transfusion Alternatives recommend that healthcare pathways be structured to ensure that anaemia screening and correction occurs 28 days before a scheduled surgical procedure (Goodnough et al, ; Kotzé et al, ; NICE, , ; Klein et al, ).…”

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confidence: 95%

Transfusion requirement and length of stay of anaemic surgical patients associated with a patient blood management service:a single‐Centre retrospective study

Faulds

Whately‐Smith

Clarke

2019

Transfusion Medicine

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Summary Objective To assess the value of patient blood management (PBM) in the detection and management of preoperative anaemia before elective surgery. Background PBM is recognised as the standard of care, with diagnosis and management of preoperative anaemia being the key components of PBM. No formal assessment of the value of PBM anaemia screening and correction before scheduled surgery had been made at our hospital. Methods We conducted a retrospective study in a tertiary‐care, academic hospital of consecutive records of elective surgery (n = 25 641). We excluded minor surgeries. We identified anaemic patients who had been assessed by PBM or not (non‐PBM). We calculated transfusion incidence and hospital length of stay (LOS) across all surgical specialities. Results During the 1‐year study period, 15 245 patients were eligible for inclusion; 311 patients (2·0%) were transfused, and 83·3% of transfusions were in anaemic patients. Transfusion incidence was 9·2% in anaemic PBM‐assessed patients and 17·4% in non‐PBM patients. For haemoglobin (Hb) <100 g L−1, the transfusion incidence was 22·1% [95% confidence interval (CI) 15·5–30·6%] in PBM and 40·0% (95% CI 35·1–45·0%) in non‐PBM patients, and for Hb 100–119 g L−1, it was 4·7% (95% CI 2·8–7·5%) and 7·9% (95% CI 6·3–9·8%), respectively. Overall mean LOS was 2·1 days [standard deviation (SD) 6·0]. Mean LOS with Hb <100 g L−1 was 6·7 days (SD 14·8) in PBM‐assessed patients and 12·4 days (SD 19·5) in non‐PBM patients and was 3·1 (SD 5·2) and 6·2 (SD 9·5) days, respectively, for Hb 100–119 g L−1. Conclusion Anaemic elective surgery patients assessed by patient blood management (PBM) had a markedly lower transfusion risk and shorter LOS than anaemic patients not assessed by PBM.

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Predictive factors for perioperative blood transfusions in partial nephrectomy for renal masses

Cited by 7 publications

References 38 publications

Perioperative Blood Transfusion Is a Predictor of Acute and Chronic Renal Function Deterioration after Partial and Radical Nephrectomy for Renal Cell Carcinoma

Perioperative Blood Transfusion Is a Predictor of Acute and Chronic Renal Function Deterioration after Partial and Radical Nephrectomy for Renal Cell Carcinoma

Impact of perioperative blood transfusions on clinical outcomes in patients undergoing surgery for major urologic malignancies

Transfusion requirement and length of stay of anaemic surgical patients associated with a patient blood management service:a single‐Centre retrospective study

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