Jesse Zuckerman1,2, Natalie Coburn1,2,3,4, Jeannie Callum5,6, Alyson L Mahar7, Victoria Zuk4, Yulia Lin5,6, Robin McLeod8, Alexis F Turgeon9,10, Haoyu Zhao11, Emily Pearsall8, Guillaume Martel12, Julie Hallet13,14,15,16. 1. Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada. 2. Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada. 3. Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada. 4. Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada. 5. Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada. 6. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada. 7. Department of Community Health Sciences, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada. 8. Department of Surgery, University of Toronto, Toronto, Canada. 9. CHU de Québec - Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Université Laval, Québec City, Canada. 10. Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Université Laval, Québec City, Canada. 11. ICES, Toronto, Canada. 12. Department of Surgery, University of Ottawa, Ottawa, Canada. 13. Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada. julie.hallet@sunnybrook.ca. 14. Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada. julie.hallet@sunnybrook.ca. 15. Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada. julie.hallet@sunnybrook.ca. 16. Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada. julie.hallet@sunnybrook.ca.
Abstract
BACKGROUND: Gastrointestinal cancer surgery patients often develop perioperative anemia commonly treated with red blood cell (RBC) transfusions. Given the potential associated risks, evidence published over the past 10 years supports restrictive transfusion practices and blood conservation programs. Whether transfusion practices have changed remains unclear. We describe temporal RBC transfusion trends in a large North American population who underwent gastrointestinal cancer surgery. METHODS: We conducted a population-based retrospective cohort study of patients who underwent gastrointestinal cancer resection between 2007 and 2018 using health administrative datasets. The outcome was RBC transfusion during hospitalization. Temporal transfusion trends were analyzed with Cochran-Armitage tests. Multivariable regression assessed the association between year of diagnosis and likelihood of RBC transfusion while controlling for confounding. RESULTS: Of 79,764 patients undergoing gastrointestinal cancer resection, the median age was 69 years old (interquartile range (IQR) 60-78 years) and 55.5% were male. The most frequent procedures were colectomy (52.8%) and proctectomy (23.0%). A total of 18,175 patients (23%) received RBC transfusion. The proportion of patients transfused decreased from 26.5% in 2007 to 18.9% in 2018 (p < 0.001). After adjusting for patient, procedure, and hospital factors, the most recent time period (2015-2018) was associated with a reduced likelihood of receiving RBC transfusion [relative risk 0.86 (95% confidence interval: 0.83-0.89)] relative to the intermediate time period (2011-2014). CONCLUSION: Over 11 years, we observed decreased RBC transfusion use and reduced likelihood of transfusion in patients undergoing gastrointestinal cancer resection. This information provides a foundation to further examine transfusion appropriateness or explore if additional transfusion minimization in surgical patients can be achieved.
BACKGROUND:Gastrointestinal cancer surgery patients often develop perioperative anemia commonly treated with red blood cell (RBC) transfusions. Given the potential associated risks, evidence published over the past 10 years supports restrictive transfusion practices and blood conservation programs. Whether transfusion practices have changed remains unclear. We describe temporal RBC transfusion trends in a large North American population who underwent gastrointestinal cancer surgery. METHODS: We conducted a population-based retrospective cohort study of patients who underwent gastrointestinal cancer resection between 2007 and 2018 using health administrative datasets. The outcome was RBC transfusion during hospitalization. Temporal transfusion trends were analyzed with Cochran-Armitage tests. Multivariable regression assessed the association between year of diagnosis and likelihood of RBC transfusion while controlling for confounding. RESULTS: Of 79,764 patients undergoing gastrointestinal cancer resection, the median age was 69 years old (interquartile range (IQR) 60-78 years) and 55.5% were male. The most frequent procedures were colectomy (52.8%) and proctectomy (23.0%). A total of 18,175 patients (23%) received RBC transfusion. The proportion of patients transfused decreased from 26.5% in 2007 to 18.9% in 2018 (p < 0.001). After adjusting for patient, procedure, and hospital factors, the most recent time period (2015-2018) was associated with a reduced likelihood of receiving RBC transfusion [relative risk 0.86 (95% confidence interval: 0.83-0.89)] relative to the intermediate time period (2011-2014). CONCLUSION: Over 11 years, we observed decreased RBC transfusion use and reduced likelihood of transfusion in patients undergoing gastrointestinal cancer resection. This information provides a foundation to further examine transfusion appropriateness or explore if additional transfusion minimization in surgical patients can be achieved.
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