Impact of Patient, Disease and Operative Factors on the Requirement for Blood Transfusion in Colorectal Cancer Surgery

In patients undergoing colorectal cancer surgery, peri-operative blood transfusions for anaemia are common, and their use has been associated with negative long-term prognosis. As such, knowledge of the risk factors for peri-operative transfusion is useful in stratifying risk to lower transfusion requirements. Data of patients undergoing bowel resection surgery for colorectal cancer between January 1, 2019, and December 31, 2020, at Blacktown Hospital was collected retrospectively. Statistical analyses were performed between blood transfusion and non-blood transfusion groups to identify risk factors that increase the need for peri-operative blood transfusions in these patients. One hundred thirty patients were analysed, with 26 requiring peri-operative blood transfusions. Stoma formation (RR = 4.22 (95% CI 1.07-16.72, p = 0.04)) and unplanned return to theatre (RR = 6.02 (95% CI 1.22-29.67, p = 0.03)) were significantly associated with increased peri-operative transfusion. Elective surgery was associated with decreased peri-operative transfusion (RR 0.22, 95% CI 0.07-0.66, p = 0.01), and of all peri-operative anticoagulants, only therapeutic enoxaparin was associated with an increase in transfusion (RR = 6.68 (95% CI 1.05-42.41, p = 0.04)). There was no correlation between tumour location and risk of peri-operative blood transfusion, as well as open or laparoscopic choice of bowel resection. There is significant evidence suggesting that stoma formation and unplanned return to OT are associated with increased peri-operative blood transfusions in colorectal cancer surgery. Elective surgery was associated with a reduction in peri-operative blood transfusions. Of all anticoagulants, only therapeutic enoxaparin was associated with an increase in blood transfusions.