Lauren S Prescott1, Thomas A Aloia2, Alaina J Brown3, Jolyn S Taylor3, Mark F Munsell4, Charlotte C Sun3, Kathleen M Schmeler3, Charles F Levenback3, Diane C Bodurka3. 1. Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States. Electronic address: lsprescott@mdanderson.org. 2. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States. 3. Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States. 4. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
Abstract
OBJECTIVE: To use a large-scale multi-institutional dataset to quantify the prevalence of packed red blood cell transfusions and examine the associations between transfusion and perioperative outcomes in gynecologic cancer surgery. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) participant use file was queried for all gynecologic cancer cases between 2010 and 2012. Demographic, preoperative and intraoperative variables were compared between transfusion and non-transfusion groups using chi-squared, Fisher's exact and Wilcoxon rank-sum tests. The primary endpoint was 30-day composite morbidity. Secondary endpoints included composite surgical site infections, mortality and length of stay. RESULTS: A total of 8519 patients were analyzed, and 13.8% received a packed red blood cell transfusion. In the multivariate analysis, after adjusting for key clinical and perioperative factors, including preoperative anemia and case magnitude, transfusion was associated with higher composite morbidity (OR = 1.85, 95% CI 1.5-2.24), surgical site infections (OR 1.80, 95% CI 1.39-2.35), mortality (OR 3.38, 95% CI 1.80-6.36) and length of hospital stay (3.02 days v. 7.17 days, P < 0.001). CONCLUSIONS: Blood transfusions are associated with increased surgical wound infections, composite morbidity and mortality. Based on our analysis of the NSQIP database, transfusion practices in gynecologic cancer should be scrutinized. Examination of institutional practices and creation of transfusion guidelines for gynecologic malignancies could potentially result in better utilization of blood bank resources and clinical outcomes among patients.
OBJECTIVE: To use a large-scale multi-institutional dataset to quantify the prevalence of packed red blood cell transfusions and examine the associations between transfusion and perioperative outcomes in gynecologic cancer surgery. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) participant use file was queried for all gynecologic cancer cases between 2010 and 2012. Demographic, preoperative and intraoperative variables were compared between transfusion and non-transfusion groups using chi-squared, Fisher's exact and Wilcoxon rank-sum tests. The primary endpoint was 30-day composite morbidity. Secondary endpoints included composite surgical site infections, mortality and length of stay. RESULTS: A total of 8519 patients were analyzed, and 13.8% received a packed red blood cell transfusion. In the multivariate analysis, after adjusting for key clinical and perioperative factors, including preoperative anemia and case magnitude, transfusion was associated with higher composite morbidity (OR = 1.85, 95% CI 1.5-2.24), surgical site infections (OR 1.80, 95% CI 1.39-2.35), mortality (OR 3.38, 95% CI 1.80-6.36) and length of hospital stay (3.02 days v. 7.17 days, P < 0.001). CONCLUSIONS: Blood transfusions are associated with increased surgical wound infections, composite morbidity and mortality. Based on our analysis of the NSQIP database, transfusion practices in gynecologic cancer should be scrutinized. Examination of institutional practices and creation of transfusion guidelines for gynecologic malignancies could potentially result in better utilization of blood bank resources and clinical outcomes among patients.
Authors: P C Hébert; G Wells; M A Blajchman; J Marshall; C Martin; G Pagliarello; M Tweeddale; I Schweitzer; E Yetisir Journal: N Engl J Med Date: 1999-02-11 Impact factor: 91.245
Authors: Nadeem R Abu-Rustum; Scott Richard; Andrew Wilton; Gali Lev; Yukio Sonoda; Martee L Hensley; Mary Gemignani; Richard R Barakat; Dennis S Chi Journal: Gynecol Oncol Date: 2005-08-02 Impact factor: 5.482
Authors: Lauren S Prescott; Jolyn S Taylor; Ahmed Enbaya; Claire A Marten; Keith N Myers; Larissa A Meyer; Pedro T Ramirez; Charles F Levenback; Diane C Bodurka; Kathleen M Schmeler Journal: Gynecol Oncol Date: 2019-03-11 Impact factor: 5.482
Authors: Lauren S Prescott; Jolyn S Taylor; Maria A Lopez-Olivo; Mark F Munsell; Helena M VonVille; David R Lairson; Diane C Bodurka Journal: Cancer Treat Rev Date: 2016-03-28 Impact factor: 12.111
Authors: Jaron Mark; Sarah Lynam; Kayla Morrell; Kevin Eng; Kristen Starbuck; J Brian Szender; Emese Zsiros; Peter J Frederick Journal: Gynecol Reprod Endocrinol Date: 2019
Authors: Gregory W Kirschen; Samantha M Dayton; Sophia Blakey-Cheung; Michael L Pearl Journal: Clin Exp Obstet Gynecol Date: 2021-02-15 Impact factor: 0.146