The impact of an integrated transfusion reduction initiative in patients undergoing resection for colorectal cancer

Froman, Joshua; Mathiason, Michelle A.; Kallies, Kara J.; Bottner, Wayne A.; Shapiro, Stephen B.

doi:10.1016/j.amjsurg.2012.05.019

Cited by 25 publications

(24 citation statements)

References 12 publications

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“…Of the 14 articles retrieved for full-text review 6 studies involving 983 participants were included for the final review: 3 randomized controlled trials [38–40] and 3 nonrandomized studies. [26, 27, 41]…”

Section: Resultsmentioning

confidence: 99%

How low should we go: A systematic review and meta-analysis of the impact of restrictive red blood cell transfusion strategies in oncology

Prescott

Taylor

López-Olivo

et al. 2016

Cancer Treatment Reviews

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Background Most non-oncologic clinical practice guidelines recommend restrictive allogeneic blood transfusion practices; however, there is a lack of consensus regarding the best transfusion practice in oncology. We conducted a systematic review of the literature to compare the efficacy and safety of restrictive versus liberal transfusion strategies in patients with cancer. Methods A literature search using MEDLINE, PUBMED and EMBASE identified all controlled studies comparing the use of restrictive with liberal transfusion in adult oncology participants up to August 10, 2015. Two review authors independently assessed studies for inclusion, extracted data and appraised the quality of the included studies. The primary outcomes of interest were blood utilization and all-cause mortality. Results Out of 4241 citations, six studies (3 randomized and 3 non-randomized) involving a total of 983 patients were included in the final review. The clinical context of the studies varied with 3 chemotherapy and 3 surgical studies. The overall risk of bias in all studies was moderate to high. Restrictive transfusion strategies were associated with a 36% reduced risk of receiving a perioperative transfusion (risk ratio (RR) 0.64, 95% confidence interval (CI) 0.49 to 0.83). There was no difference in mortality between the strategies (RR 1.00, 95% CI 0.32 to 3.18). There were no differences in adverse events reported between the restrictive and liberal transfusion strategies. Conclusion Restrictive strategy appears to decrease blood utilization without increasing morbidity or mortality in oncology. This review is limited by a paucity of high quality studies on this topic. Better designed studies are warranted.

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Section: Resultsmentioning

confidence: 99%

How low should we go: A systematic review and meta-analysis of the impact of restrictive red blood cell transfusion strategies in oncology

Prescott

Taylor

López-Olivo

et al. 2016

Cancer Treatment Reviews

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“…Comprehensive transfusion reduction initiatives involving blood conservation consultants, institutional guidelines and the use of alternative transfusion strategies have successfully been implemented. 39,40 Similar strategies for patients with gastric cancer could be adopted and could also include medical interventions like the use of iron supplementation (alone or in combination with erythropoietin for anemic patients) and antifibrinolytic agents to reduce the need for RBCT. 41,42 Further research is required to determine whether blood-conserving tactics (with potential ensuing reduction in transfusion rates) would actually translate into improved outcomes in gastric cancer surgery.…”

Section: Discussionmentioning

confidence: 99%

The impact of blood transfusion on perioperative outcomes following gastric cancer resection: an analysis of the American College of Surgeons National Surgical Quality Improvement Program database

et al. 2016

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Background: Red blood cell transfusions (RBCT) carry risk of transfusion-related immunodulation that may impact postoperative recovery. This study examined the association between perioperative RBCT and short-term postoperative outcomes following gastrectomy for gastric cancer. Methods:Using the American College of Surgeons National Surgical Quality Improvement Program database, we compared outcomes of patients (transfused v. nontransfused) undergoing elective gastrectomy for gastric cancer (2007)(2008)(2009)(2010)(2011)(2012). Outcomes were 30-day major morbidity, mortality and length of stay. The association between perioperative RBCT and outcomes was estimated using modified Poisson, logistic, or negative binomial regression. Results:Of the 3243 patients in the entire cohort, we included 2884 patients with nonmissing data, of whom 535 (18.6%) received RBCT. Overall 30-day major morbidity and mortality were 20% and 3.5%, respectively. After adjustment for baseline and clinical characteristics, RBCT was independently associated with increased 30-day mortality (relative risk [RR] 3.1, 95% confidence interval [CI] 1.9-5.0), major morbidity (RR 1.4, 95% CI 1.2-1.8), length of stay (RR 1.2, 95% CI 1.1-1.2), infections (RR 1.4, 95% CI 1.1-1.6), cardiac complications (RR 1.8, 95% CI 1.0-3.2) and respiratory failure (RR 2.3, 95% CI 1.6-3.3). Conclusion:Red blood cell transfusions are associated with worse postoperative short-term outcomes in patients with gastric cancer. Blood management strategies are needed to reduce the use of RBCT after gastrectomy for gastric cancer.Contexte : Les transfusion de globules rouges (TGR) entrainent une immunosuppression qui peut entraver la récupération post-opératoire. Cette étude évalue l'association entre les TGR péri-opératoires et l'issue post-opératoire après gastrectomie pour cancer gastrique (CG). Conclusion :Les TGR sont associées à une détérioration de l'issue post-opératoire après gastrectomie pour CG, dont la morbidité majeure, la mortalité, et la durée d'hospitalisation. Des stratégies multidisciplinaires de gestion du risque transfusionnel sont nécessaires afin de limiter l'utilisation des TGRs après gastrectomie pour CG.

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“…Comprehensive blood management programs can effectively reduce the use of perioperative RBCT as well as improve post-operative outcomes and save costs (41)(42)(43)(44). However, the successful implementation of these programs requires buy-in from primary stakeholders caring for the patients.…”

Section: Discussionmentioning

confidence: 99%

The impact of perioperative blood transfusions on short-term outcomes following hepatectomy

Hallet¹,

Mahar²,

Nathens³

et al. 2018

Hepatobiliary Surg. Nutr.

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Background: Bleeding and need for red blood cell transfusions (RBCT) remain a significant concern with hepatectomy. RBCT carry risk of transfusion-related immunomodulation that may impact post-operative recovery. This study soughs to assess the association between RBCT and post-hepatectomy morbidity. Two exposure groups were created based on RBCT. Primary outcomes were 30-day major morbidity and mortality. Secondary outcomes included 30-day system-specific morbidity and length of stay (LOS). Relative risks (RR) with 95% confidence interval (95% CI) were computed using regression analyses. Sensitivity analyses were conducted to understand how missing data might have impacted the results.Results: A total of 12,180 patients were identified. Of those, 11,712 met inclusion criteria, 2,951 (25.2%) of whom received RBCT. Major morbidity occurred in 14.9% of patients and was strongly associated with RBCT (25.3% vs. 11.3%; P<0.001). Transfused patients had higher rates of 30-day mortality (5.6% vs. 1.0%; P<0.0001). After adjustment for baseline and clinical characteristics, RBCT was independently associated with increased major morbidity (RR 1.80; 95% CI: 1.61-1.99), mortality (RR 3.62; 95% CI: 2.68-4.89), and 1.29 times greater LOS (RR 1.29; 95% CI: 1.25-1.32). Results were robust to a number of sensitivity analyses for missing data.Conclusions: Perioperative RBCT for hepatectomy was independently associated with worse shortterm outcomes and prolonged LOS. These findings further the rationale to focus on minimizing RBCT for hepatectomy, when they can be avoided.

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The impact of an integrated transfusion reduction initiative in patients undergoing resection for colorectal cancer

Cited by 25 publications

References 12 publications

How low should we go: A systematic review and meta-analysis of the impact of restrictive red blood cell transfusion strategies in oncology

How low should we go: A systematic review and meta-analysis of the impact of restrictive red blood cell transfusion strategies in oncology

The impact of blood transfusion on perioperative outcomes following gastric cancer resection: an analysis of the American College of Surgeons National Surgical Quality Improvement Program database

The impact of perioperative blood transfusions on short-term outcomes following hepatectomy

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