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

被引:44
作者
Elmi, Maryam [1 ]
Mahar, Alyson [2 ]
Kagedan, Daniel [1 ]
Law, Calvin H. L. [1 ,3 ]
Karanicolas, Paul J. [1 ,3 ]
Lin, Yulia [4 ,5 ]
Callum, Jeannie [4 ,5 ]
Coburn, Natalie G. [1 ,3 ]
Hallet, Julie [1 ,3 ]
机构
[1] Univ Toronto, Dept Surg, Toronto, ON, Canada
[2] Queens Univ, Dept Publ Hlth Sci, Kingston, ON, Canada
[3] Odette Canc Ctr, Sunnybrook Hlth Sci Ctr, Div Gen Surg, Toronto, ON, Canada
[4] Sunnybrook Hlth Sci Ctr, Div Clin Pathol, Toronto, ON, Canada
[5] Univ Toronto, Dept Lab Med & Pathobiol, Toronto, ON, Canada
关键词
ADJUVANT CHEMOTHERAPY; COLORECTAL-CANCER; SURVIVAL; INFECTION; RISK; RECURRENCE; MECHANISMS; IMMUNOMODULATION; METAANALYSIS; ASSOCIATION;
D O I
10.1503/cjs.004016
中图分类号
R61 [外科手术学];
学科分类号
摘要
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. non-transfused) undergoing elective gastrectomy for gastric cancer (2007-2012). 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.
引用
收藏
页码:322 / 329
页数:8
相关论文
共 41 条
[1]   The Prevention of Transfusion-Associated Circulatory Overload [J].
Alam, Asim ;
Lin, Yulia ;
Lima, Ana ;
Hansen, Mark ;
Callum, Jeannie L. .
TRANSFUSION MEDICINE REVIEWS, 2013, 27 (02) :105-112
[2]   Gastric cancer: epidemiology, pathology and treatment [J].
Alberts, SR ;
Cervantes, A ;
van de Velde, CJH .
ANNALS OF ONCOLOGY, 2003, 14 :31-36
[3]   Return to Intended Oncologic Treatment (RIOT): A Novel Metric for Evaluating the Quality of Oncosurgical Therapy for Malignancy [J].
Aloia, Thomas A. ;
Zimmitti, Giuseppe ;
Conrad, Claudius ;
Gottumukalla, Vijaya ;
Kopetz, Scott ;
Vauthey, Jean-Nicolas .
JOURNAL OF SURGICAL ONCOLOGY, 2014, 110 (02) :107-114
[4]  
[Anonymous], 1959, WHO TECH REP SER
[5]   Intraoperative Transfusion of 1 U to 2 U Packed Red Blood Cells Is Associated with Increased 30-Day Mortality, Surgical-Site Infection, Pneumonia, and Sepsis in General Surgery Patients Discussion [J].
Richardson, J. David ;
Meredith, J. Wayne ;
Bernard, Andrew C. .
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2009, 208 (05) :938-939
[6]   Association Between Time to Initiation of Adjuvant Chemotherapy and Survival in Colorectal Cancer A Systematic Review and Meta-analysis [J].
Biagi, James J. ;
Raphael, Michael J. ;
Mackillop, William J. ;
Kong, Weidong ;
King, Will D. ;
Booth, Christopher M. .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2011, 305 (22) :2335-2342
[7]  
BLUMBERG N, 1994, ARCH PATHOL LAB MED, V118, P371
[8]   Liberal or Restrictive Transfusion in High-Risk Patients after Hip Surgery [J].
Carson, Jeffrey L. ;
Terrin, Michael L. ;
Noveck, Helaine ;
Sanders, David W. ;
Chaitman, Bernard R. ;
Rhoads, George G. ;
Nemo, George ;
Dragert, Karen ;
Beaupre, Lauren ;
Hildebrand, Kevin ;
Macaulay, William ;
Lewis, Courtland ;
Cook, Donald Richard ;
Dobbin, Gwendolyn ;
Zakriya, Khwaja J. ;
Apple, Fred S. ;
Horney, Rebecca A. ;
Magaziner, Jay .
NEW ENGLAND JOURNAL OF MEDICINE, 2011, 365 (26) :2453-2462
[9]   Optimizing ACS NSQIP Modeling for Evaluation of Surgical Quality and Risk: Patient Risk Adjustment, Procedure Mix Adjustment, Shrinkage Adjustment, and Surgical Focus [J].
Cohen, Mark E. ;
Ko, Clifford Y. ;
Bilimoria, Karl Y. ;
Zhou, Lynn ;
Huffman, Kristopher ;
Wang, Xue ;
Liu, Yaoming ;
Kraemer, Kari ;
Meng, Xiangju ;
Merkow, Ryan ;
Chow, Warren ;
Matel, Brian ;
Richards, Karen ;
Hart, Amy J. ;
Dimick, Justin B. ;
Hall, Bruce L. .
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2013, 217 (02) :336-+
[10]   Perioperative complications influence recurrence and survival after resection of hepatic colorectal metastases [J].
Correa-Gallego, C. ;
Gonen, M. ;
Fischer, M. ;
Grant, F. ;
Kemeny, N. E. ;
Arslan-Carlon, V. ;
Kingham, T. P. ;
DeMatteo, R. P. ;
Fong, Y. ;
Allen, P. J. ;
D'Angelica, M. I. ;
Jarnagin, W. R. .
ANNALS OF SURGICAL ONCOLOGY, 2013, 20 (08) :2477-2484