The true risk of blood transfusion after nephrectomy for renal masses: a population‐based study

Abstract

What's known on the subject? and What does the study add?• There is a paucity of population-based analyses of expected outcomes after renal surgery for kidney cancer. Reported blood transfusion rates after nephrectomy show considerable variability, probably as a result of the referral patterns that influence reports from tertiary academic medical centres.• With emerging data on the inferior outcomes in patients undergoing allogeneic blood transfusion, we aimed to evaluate the patient, surgeon and hospital factors that influence the receipt of a blood transfusion after nephrectomy. A more detailed understanding of these factors may help in preoperative patient counselling and informed consent. Objective• To examine blood transfusion rates after nephrectomy for renal masses at the population-level. Patients and Methods• We performed a population-based, retrospective observational study using a national discharge abstract database.• The study cohort consisted of 10 902 patients who were treated by radical nephrectomy (RN) or partial nephrectomy (PN) for a renal mass between 1 April 2003 and 31 March 2008.• The association between blood transfusion and various explanatory variables was examined using the chi-squared test and multivariable logistic regression. Results• The overall blood transfusion rate was 18.1%.• Transfusions occurred after 28.2%, 12.7%, 9.2% and 8.6% of open RN, open PN, laparoscopic RN and laparoscopic PN, respectively (P < 0.001).• Transfusion rates were found to be strongly associated with age and comorbidity, such that patients aged <50years with Charlson scores of 0 were transfused 11.2% and 14.5% of the time compared to 28.2% and 40.7% in patients aged Ն80 years with Charlson scores of Ն3, respectively (P < 0.001).• On multivariable logistic regression, age (P < 0.001),Charlson score (P < 0.001), procedure type (P < 0.001), surgeon (P < 0.001) and hospital volume quartile (P < 0.001) were all found to be associated with the rate of blood transfusions, whereas year of surgery, sex and income quintile were not. Conclusions• The transfusion rate after nephrectomy in general clinical practice is higher than that reported in the urological literature.• Patient and provider factors appear to contribute to the considerable variability that exists in the observed transfusion rate.• A more detailed understanding of these factors may help with respect to preoperative patient counselling and informed consent.

The impact of perioperative blood transfusion on survival after nephrectomy for non‐metastatic renal cell carcinoma (RCC)

“…The reported rates of PBT with nephrectomy have varied considerably and probably also reflect disparate populations studied, as well as a lack of standardised criteria for transfusion. Notably, a recent population‐based study of 10 902 nephrectomies reported a transfusion rate of 18.1% , similar to our experience here (21%). Contributing to our rate of PBT, may also be the tertiary referral nature of our practice, as 46% of those who received a PBT had pT3/4 disease.…”

“…Notably, nephrectomy (including partial and radical) has been associated with a perioperative blood transfusion (PBT) rate ranging from 3.5% to 18.1% . Previous reports have shown an increased risk of cancer recurrence in patients receiving a PBT after surgery for colon, hepatic and oesophageal malignancies .…”

886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

“…106,111 The Charlson comorbidity index has also been associated with mortality in the setting of kidney cancer patients 112 , as well as with blood transfusion rates in patients undergoing nephrectomy for renal masses. 113 …”

Patient and disease factors predictive of adverse perioperative outcomes after nephrectomy

“…For over 10,000 patients recorded on a Canadian discharge database, an overall transfusion rate of 18.1% was reported. 5 Multivariate logistic regression showed an association between age, Charlson co-morbidity index, procedure type, surgeon and hospital volume, and need for blood transfusion. Our study has some limitations.…”

“…4 The blood transfusion rate from a national database was 18.1%. 5 The British Association of Urological Surgeons (BAUS) nephrectomy database was launched in 2001 to collect surgeon reported outcome data. Data submission was voluntary.…”