Christina M Papageorge1, Gregory D Kennedy2, Evie H Carchman3. 1. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI. Electronic address: cpapageorge@uwhealth.org. 2. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Surgery, University of Alabama-Birmingham School of Medicine, Birmingham, AL. 3. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Abstract
BACKGROUND: Both anemia and blood transfusion are associated with poor outcomes. The aim of this study was to evaluate the effect of preoperative blood transfusion on postoperative outcomes after colectomy, stratified by severity of anemia. METHODS: Patients undergoing colectomy from 2012-2014 were selected from the National Surgical Quality Improvement Program targeted colectomy database. Patients were divided into 2 groups based on receipt of preoperative transfusion and then stratified by hematocrit. Univariate and multivariate analyses were used to compare 30-day outcomes between the 2 groups. RESULTS: A total of 60,785 patients were included in the study, with an overall preoperative transfusion rate of 3.4% (n = 2,073). On univariate analysis, transfusion was associated with significantly greater rates of postoperative morbidity. The risk-adjusted, multivariate model confirmed increased risk of complications with preoperative transfusion (odds ratio 1.32, 95% confidence interval, 1.18-1.48). Furthermore, transfusion did not improve outcomes even in the setting of moderate anemia (odds ratio 1.35, 95% confidence interval, 1.14-1.60) or severe anemia (odds ratio 0.97, 95% confidence interval, 0.66-1.41). CONCLUSIONS: Preoperative transfusion is an independent predictor of complications in patients with mild and moderate anemia. Furthermore, these retrospective data suggest that even severely anemic patients do not benefit from preoperative transfusion and empiric transfusion therefore should be avoided. Alternatives to preoperative optimization of this high-risk surgical population should be sought.
BACKGROUND: Both anemia and blood transfusion are associated with poor outcomes. The aim of this study was to evaluate the effect of preoperative blood transfusion on postoperative outcomes after colectomy, stratified by severity of anemia. METHODS:Patients undergoing colectomy from 2012-2014 were selected from the National Surgical Quality Improvement Program targeted colectomy database. Patients were divided into 2 groups based on receipt of preoperative transfusion and then stratified by hematocrit. Univariate and multivariate analyses were used to compare 30-day outcomes between the 2 groups. RESULTS: A total of 60,785 patients were included in the study, with an overall preoperative transfusion rate of 3.4% (n = 2,073). On univariate analysis, transfusion was associated with significantly greater rates of postoperative morbidity. The risk-adjusted, multivariate model confirmed increased risk of complications with preoperative transfusion (odds ratio 1.32, 95% confidence interval, 1.18-1.48). Furthermore, transfusion did not improve outcomes even in the setting of moderate anemia (odds ratio 1.35, 95% confidence interval, 1.14-1.60) or severe anemia (odds ratio 0.97, 95% confidence interval, 0.66-1.41). CONCLUSIONS: Preoperative transfusion is an independent predictor of complications in patients with mild and moderate anemia. Furthermore, these retrospective data suggest that even severely anemicpatients do not benefit from preoperative transfusion and empiric transfusion therefore should be avoided. Alternatives to preoperative optimization of this high-risk surgical population should be sought.
Authors: Jeffrey L Carson; Michael L Terrin; Helaine Noveck; David W Sanders; Bernard R Chaitman; George G Rhoads; George Nemo; Karen Dragert; Lauren Beaupre; Kevin Hildebrand; William Macaulay; Courtland Lewis; Donald Richard Cook; Gwendolyn Dobbin; Khwaja J Zakriya; Fred S Apple; Rebecca A Horney; Jay Magaziner Journal: N Engl J Med Date: 2011-12-14 Impact factor: 91.245
Authors: Stefan W Leichtle; Nicolas J Mouawad; Richard Lampman; Bonita Singal; Robert K Cleary Journal: J Am Coll Surg Date: 2011-02 Impact factor: 6.113
Authors: Wen-Chih Wu; Tracy S Smith; William G Henderson; Charles B Eaton; Roy M Poses; Georgette Uttley; Vincent Mor; Satish C Sharma; Michael Vezeridis; Shukri F Khuri; Peter D Friedmann Journal: Ann Surg Date: 2010-07 Impact factor: 12.969
Authors: Gavin J Murphy; Katie Pike; Chris A Rogers; Sarah Wordsworth; Elizabeth A Stokes; Gianni D Angelini; Barnaby C Reeves Journal: N Engl J Med Date: 2015-03-12 Impact factor: 91.245
Authors: Alexander B Pothof; Thomas C F Bodewes; Thomas F X O'Donnell; Sarah E Deery; Katie Shean; Peter A Soden; Gert J de Borst; Marc L Schermerhorn Journal: J Vasc Surg Date: 2017-08-16 Impact factor: 4.268
Authors: Byron D Hughes; Christian Sommerhalder; E Martin Sieloff; Kari E Williams; Douglas S Tyler; Anthony J Senagore Journal: Healthcare (Basel) Date: 2020-12-02