The negative effect of perioperative red blood cell transfusion on morbidity and mortality after major abdominal operations

Elwood, Nathan R.; Martin, Allison N.; Turrentine, Florence E.; Rs, Jones; Zaydfudim, Victor M.

doi:10.1016/j.amjsurg.2018.02.015

Cited by 25 publications

(17 citation statements)

References 33 publications

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“…Severe anemia and massive bleeding are critical condition associated with various unfavorable outcomes, and allogenic blood transfusion is the most common treatment [20,28–30]. However, numerous studies have found that PRBC transfusion was associated with adverse short- and long-term outcomes, especially in surgery patients when transfused perioperatively or intraoperatively [12–15].…”

Section: Discussionmentioning

confidence: 99%

“…However, overutilization of FPC is common, since there is no consensus on the optimal indication and threshold for utilization of FPC. Perioperative or intraoperative transfusion of FFP and platelet has been found to increase the risk of postoperative complications in several studies but not in others [13,18–20].…”

Section: Introductionmentioning

confidence: 99%

“…There is still no strong evidence of the potential influence of intraoperative PRBC and FPC transfusion on immediate outcome of patients following LR. Moreover, most patients in the previous studies enrolled as PRBC or FFP transfusion groups were probably transfused with both [16–20], since most patients undergoing liver surgery needed transfusion with both PRBC and the “yellow” blood products. Therefore, the results might reflect a dual influence of “red” and “yellow” blood products on postoperative morbidity.…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative Blood Transfusion and Postoperative Morbidity Following Liver Resection

Zhang

Gao

et al. 2018

Med Sci Monit

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BackgroundBlood transfusion is common during liver resection (LR). The objective of the present study was to investigate the effects of intraoperative transfusion of different blood components on post-LR morbidity.Material/MethodsWe included 610 patients undergoing LR and grouped them according to intraoperative transfusion of different blood components: packed red blood cells only (PRBC, n=81); frozen fresh plasma, platelets, and cryoprecipitate (FPC, n=38); transfusion only with PRBC + FPC transfusion (n=244); and no blood transfusion (n=247). Propensity score matching (PSM) analysis was used to mitigate selection bias in comparisons.ResultsThe overall blood transfusion rate was 59.5%. In comparison with the no blood transfusion group, PRBC-only and PRBC + FPC transfusion were more common in patients with lower preoperative hemoglobin, worse liver function, larger tumor size, and undergoing a major LR, and thus were associated with increased postoperative morbidity. In contrast, FPC-only transfusion was more frequent in patients with a liver function of Child-Pugh B and lower preoperative albumin vs. the no blood transfusion group. In the propensity model, transfusion of PRBC (PRBC-only and PRBC+FPC) and FPC (FPC-only and FPC+PRBC) were significantly associated with increased postoperative complications vs. the no blood transfusion group (OR and 95% CI, 1.9 [1.2–2.7], p=0.002; OR and 95% CI, 1.6 [1.0–2.4], p=0.029). In contrast, intraoperative PRBC-only or FPC-only transfusion showed no significant adverse effects on postoperative morbidity.ConclusionsAllogenic transfusion of PRBC and FPC blood components was associated with increased postoperative morbidity after liver surgery. Different blood components should be used only when absolutely necessary.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intraoperative Blood Transfusion and Postoperative Morbidity Following Liver Resection

Zhang

Gao

et al. 2018

Med Sci Monit

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“…In previous retrospective studies, perioperative blood transfusions were associated with poor prognosis after surgery for cancer, and were a major independent risk factor for postoperative bacterial infection [16,17]. Patients receiving intraoperative blood transfusion often have anemia before operation or large intraoperative blood loss during surgery.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes and prognostic factor analysis of resected Siewert type II adenocarcinoma of esophagogastric junction in China: a seven-year study

Feng

Jiang

Zhao

et al. 2020

Preprint

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BACKGROUND The incidence rate of adenocarcinoma of esophagogastric junction (AEG) was significantly increased over the past two decades. Surgery remians the only way to cure. Indeed, there are currently few studies on Chinese AEG patients. The purpose of this study was to retrospectively analyze the survival and prognostic factors of AEG patients in our center. METHODS Between January 2008 and September 2014, 249 AEG patients who underwent radical resection were enrolled in this retrospective study, including 196 males and 53 females, with a median age of 64 (range 31–82). Prognostic factors were assessed with Log-rank test, Cox univariate and multivariate analysis. RESULTS The 5-year survival rate of all patients was 49%. The median survival time of all enrolled patients was 70.1 months. Pathology type, intraoperative blood transfusion, tumor size, adjuvant chemotherapy, hospital stay days, serum CA199, CA125, CA242 and CEA, pTNM stage, lymphovascular or perineuronal invasion, and the ratio of positive to negative lymph nodes (PNLNR) were significant associated with overall survival when analyzed with univariate analysis. CONCLUSIONS Our study found that intraoperative blood transfusion, tumor size, adjuvant chemotherapy, serum CEA and PNLNR, postoperative hospital stays were independent risk factors.

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“…Laparoscopic gastrointestinal resection includes small bowel and colon resections. These operations were highly associated with a red blood cell (RBC) transfusion (2). Inflammation is a nonspecific response of the organism to endogenous or exogenous stimulants to maintain the survival.…”

Section: Introductionmentioning

confidence: 99%

Clinical and prognostic significance of preoperative and postoperative neutrophil/lymphocyte ratio and platelet/ lymphocyte ratio in patients undergoing major abdominal surgery

Hançerlioğulları¹,

Kaymak²,

Okuyucu³

et al. 2018

Gulhane Med J

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Aims: Acute inflammatory processes are associated with perioperative complications. Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) were reported to have prognostic importance in various diseases. We aimed to investigate the clinical importance of preoperative (preop) and postoperative (postop) NLR and PLR as predictors of morbidity and surgical or nonsurgical complications after major abdominal surgery. Methods: Patients who had a major abdominal surgery were retrospectively evaluated. Age, gender, American Society of Anesthesiologist (ASA) score, and the type of operation were recorded. Preop and postop days 1, 3 and 5 white blood cell (WBC), neutrophil, lymphocyte and platelet counts, duration of intensive care unit stay and hospitalization, Clavien Dindo classification, and surgical or non-surgical complications were determined. Results: The study included 462 subjects. Concerning increased need for red blood cell transfusions, NLR was significantly higher on postop day 3 but lower on day 5, and PLR was higher on postop day 1 compared to preop state. Regarding a worse Clavien-Dindo classification, NLR was higher on postop day 3 but lower on day 5, and PLR was higher on postop day 1 and 3 compared to baseline. In those with increased surgical complications, NLR was lower on postop day 5, and postop day 1 and 3 PLR were higher compared to baseline values. In subjects with higher non-surgical complications, NLR was higher on postop day 3 but lower on day 5 compared to preop measurements. PLR was similar across the days of follow up in terms of non-surgical complications. Conclusions: Higher NLR on postoperative day 5, and higher PLR on postoperative days 1 and 3 compared to preop values were the indicators of increased complications in this study.

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The negative effect of perioperative red blood cell transfusion on morbidity and mortality after major abdominal operations

Abstract: Perioperative blood transfusion is independently associated with an increased risk of morbidity and mortality after most major abdominal operations.

Cited by 25 publications

References 33 publications

Intraoperative Blood Transfusion and Postoperative Morbidity Following Liver Resection

Intraoperative Blood Transfusion and Postoperative Morbidity Following Liver Resection

Long-term outcomes and prognostic factor analysis of resected Siewert type II adenocarcinoma of esophagogastric junction in China: a seven-year study

Clinical and prognostic significance of preoperative and postoperative neutrophil/lymphocyte ratio and platelet/ lymphocyte ratio in patients undergoing major abdominal surgery

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