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Predictive factors for perioperative blood transfusions in laparoscopic colorectal surgery

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Allogeneic perioperative blood transfusion (PBT) has been associated with higher rates of postoperative complications in patients undergoing colorectal surgery and increased tumor recurrence in cancer patients. Our aim is to evaluate possible predictive factors for PBT, specifically, in patients undergoing laparoscopic colorectal surgery, in order to identify patients who could benefit from alternatives to allogenic PBT such as erythropoietin administration, autologous blood transfusion, and possibly preoperative blood transfusion.

Methods

Five hundred patients who underwent laparoscopic colorectal surgery between the years 2003 and 2011 were reviewed. Patient demographics and clinicopathologic variables were collected prospectively. Other clinical data were collected directly from the computerized records of the in-hospital blood bank. PBT was defined as transfusion of allogenic red blood cells during the day of operation or within the postoperative hospitalization. The associations between PBT and patient variables were assessed by univariate and multivariate analyses.

Results

Of the 500 patients, 134 patients (26.8 %) received PBT. Multivariate analysis revealed four preoperative variables as significant risk factors for PBT: preoperative hemoglobin (P = 0.001), lower rectal surgery (P = 0.009), Charlson comorbidity score (P = 0.001), and malignancy (P = 0.024).

Conclusions

Preoperative Charlson score, hemoglobin level, carcinoma, and lower rectum pathologies were found to be independent risk factors for PBT in patients undergoing laparoscopic colorectal surgery. Evaluation of these risk factors prior to surgery may be helpful in selecting the patients who could benefit from possible alternatives to perioperative allogeneic blood transfusion and help constitute guidelines for a more responsible use of these alternatives.

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References

  1. Jagoditsch M, Pozgainer P, Klingler A, Tschmelitsch J (2006) Impact of blood transfusions on recurrence and survival after rectal cancer surgery. Dis Colon Rectum 49(8):1116–1130

    Article  PubMed  Google Scholar 

  2. Benoist S, Panis Y, Pannegeon V, Alves A, Valleur P (2001) Predictive factors for perioperative blood transfusions in rectal resection for cancer: a multivariate analysis of a group of 212 patients. Surgery 129(4):433–439

    Article  CAS  PubMed  Google Scholar 

  3. Amato A, Pescatori M (2011) Perioperative blood transfusions and recurrence of colorectal cancer (review) no. 2

  4. Schreiber GB, Busch MP, Kleinman SH, Korelitz JJ (1996) The risk of transfusion-transmitted viral infections. The Retrovirus Epidemiology Donor Study. N Engl J Med 334(26):1685–1690

    Article  CAS  PubMed  Google Scholar 

  5. Ghinea R, Greenberg I, White E, Sacham-Shmueli H, Mahagna, S. Avital (2013) Perioperative blood transfusion in cancer patients undergoing laparoscopic colorectal resection: risk factors and impact on survival. Tech Coloproctol

  6. Tartter PI (1988) Blood transfusion and infectious complications following colorectal cancer surgery. Brit J Surg 75(8):789–792

    Article  CAS  PubMed  Google Scholar 

  7. Wobbes T, Bemelmans BL, Kuypers JH, Beerthuizen GI, Theeuwes AG (1990) Risk of postoperative septic complications after abdominal surgical treatment in relation to perioperative blood transfusion. Surg Gynecol Obstet 171(1):59–62

    CAS  PubMed  Google Scholar 

  8. Edna TH, Bjerkeset T (1998) Perioperative blood transfusions reduce long-term survival following surgery for colorectal cancer. Dis Colon Rectum 41(4):451–459

    Article  CAS  PubMed  Google Scholar 

  9. Blumberg N, Agarwal MM, Chuang C (1985) Relation between recurrence of cancer of the colon and blood transfusion. Br Med J (Clin Res Ed) 290(6474):1037–1039

    Article  CAS  Google Scholar 

  10. Burrows L, Tartter P (1982) Effect of blood transfusions on colonic malignancy recurrent rate. Lancet 2(8299):662

    Article  CAS  PubMed  Google Scholar 

  11. Amato AC, Pescatori M (1998) Effect of perioperative blood transfusions on recurrence of colorectal cancer: meta-analysis stratified on risk factors. Dis Colon Rectum 41(5):570–585

    Article  CAS  PubMed  Google Scholar 

  12. Linder BJ, Frank I, Cheville JC, Tollefson MK, Thompson RH, Tarrell RF, Thapa P, Boorjian SA (2013) The impact of perioperative blood transfusion on cancer recurrence and survival following radical cystectomy. Eur Urol 63(5):839–845

    Article  PubMed  Google Scholar 

  13. Braga M, Vignali A, Gianotti L, Zuliani W, Radaelli G, Gruarin P, Dellabona P, Di Carlo V (2002) Laparoscopic versus open colorectal surgery: a randomized trial on short-term outcome. Ann Surg 236(6):759–766, discussion 767

    Article  PubMed Central  PubMed  Google Scholar 

  14. Heiss MM, Mempel W, Delanoff C, Jauch KW, Gabka C, Mempel M, Dieterich HJ, Eissner HJ, Schildberg FW (1994) Blood transfusion-modulated tumor recurrence: first results of a randomized study of autologous versus allogeneic blood transfusion in colorectal cancer surgery. J Clin Oncol Off J Am Soc Clin Oncol 12(9):1859–1867

    CAS  Google Scholar 

  15. Gohel MS, Bulbulia RA, Slim FJ, Poskitt KR, Whyman MR (2005) How to approach major surgery where patients refuse blood transfusion (including Jehovah’s Witnesses). Ann R Coll Surg Engl 87(1):3–14

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Miki C, Hiro J, Ojima E, Inoue Y, Mohri Y, Kusunoki M (2006) Perioperative allogeneic blood transfusion, the related cytokine response and long-term survival after potentially curative resection of colorectal cancer. Clin Oncol 18(1):60–66

    CAS  Google Scholar 

  17. Kim J, Konyalian V, Huynh R, Mittal R, Stamos M, Kumar R (2007) Identification of predictive factors for perioperative blood transfusion in colorectal resection patients. Int J Colorectal Dis 22(12):1493–1497

    Google Scholar 

  18. Tang R, Wang JY, Chien CR, Chen JS, Lin SE, Fan HA (1993) The association between perioperative blood transfusion and survival of patients with colorectal cancer. Cancer 72(2):341–348

    Article  CAS  PubMed  Google Scholar 

  19. Sabalić S, Kovacević D, Glavić Z, Buković D, Despot A, Fajdić J, Lukac J, Seso I (2006) The immunomodulation effect of allogenic blood transfusion in colorectal cancer—a new approach. Coll Antropol 30(4):885–893

    PubMed  Google Scholar 

  20. Gascón P, Zoumbos NC, Young NS (1984) Immunologic abnormalities in patients receiving multiple blood transfusions. Ann Intern Med 100(2):173–177

    Article  PubMed  Google Scholar 

  21. Ghio M, Contini P, Mazzei C, Brenci S, Barberis G, Filaci G, Indiveri F, Puppo F (1999) Soluble HLA class I, HLA class II, and Fas ligand in blood components: a possible key to explain the immunomodulatory effects of allogeneic blood transfusions. Blood 93(5):1770–1777

    CAS  PubMed  Google Scholar 

  22. Kaplan J, Sarnaik S, Gitlin J, Lusher J (1984) Diminished helper/suppressor lymphocyte ratios and natural killer activity in recipients of repeated blood transfusions. Blood 64(1):308–310

    CAS  PubMed  Google Scholar 

  23. Opelz G, Terasaki PI (1974) Poor kidney-transplant survival in recipients with frozen-blood transfusions or no transfusions. Lancet 2(7882):696–698

    Article  CAS  PubMed  Google Scholar 

  24. Edna TH, Bjerkeset T (1992) Association between blood transfusion and infection in injured patients. J Trauma 33(5):659–661

    Article  CAS  PubMed  Google Scholar 

  25. Jensen LS, Andersen AJ, Christiansen PM, Hokland P, Juhl CO, Madsen G, Mortensen J, Møller-Nielsen C, Hanberg-Sørensen F, Hokland M (1992) Postoperative infection and natural killer cell function following blood transfusion in patients undergoing elective colorectal surgery. Br J Surg 79(6):513–516

    Article  CAS  PubMed  Google Scholar 

  26. Bernard AC, Davenport DL, Chang PK, Vaughan TB, Zwischenberger JB (2009) 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. J Am Coll Surg 208(5):931–937, 937.e1–2; discussion 938–9

    Article  PubMed  Google Scholar 

  27. Torchia MG, Danzinger RG (2000) Perioperative blood transfusion and albumin administration are independent risk factors for the development of postoperative infections after colorectal surgery. Can J Surg J Can Chir 43(3):212–216

    CAS  Google Scholar 

  28. Moore FA, Moore EE, Sauaia A (1997) Blood transfusion. An independent risk factor for postinjury multiple organ failure. Arch Surgery (Chicago, Ill: 1960) 132(6):620–624, discussion 624–5

    Article  CAS  Google Scholar 

  29. Malone DL, Dunne J, Tracy JK, Putnam AT, Scalea TM, Napolitano LM (2003) Blood transfusion, independent of shock severity, is associated with worse outcome in trauma. J Trauma 54(5):898–905, discussion 905–7

    Article  PubMed  Google Scholar 

  30. Amato A, Pescatori M (2006) Perioperative blood transfusions for the recurrence of colorectal cancer. Cochrane Database Syst Rev 1: CD005033

  31. Busch OR, Hop WC, Marquet RL, Jeekel J (1994) Blood transfusions and local tumor recurrence in colorectal cancer. Evidence of a noncausal relationship. Ann Surg 220(6):791–797

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. Kosmadakis N, Messaris E, Maris A, Katsaragakis S, Leandros E, Konstadoulakis MM, Androulakis G (2003) Perioperative erythropoietin administration in patients with gastrointestinal tract cancer: prospective randomized double-blind study. Ann Surg 237(3):417–421

    PubMed Central  PubMed  Google Scholar 

  33. Karkouti K, McCluskey SA, Evans L, Mahomed N, Ghannam M, Davey R (2005) Erythropoietin is an effective clinical modality for reducing RBC transfusion in joint surgery. Can J Anaesth J Can Anesth 52(4):362–368

    Article  Google Scholar 

  34. Kettelhack C, Hönes C, Messinger D, Schlag PM (1998) Randomized multicentre trial of the influence of recombinant human erythropoietin on intraoperative and postoperative transfusion need in anaemic patients undergoing right hemicolectomy for carcinoma. Bri J Surg 85(1):63–67

    CAS  Google Scholar 

  35. Nursal TZ, Hamaloğlu E (2006) The effect of preoperative blood transfusion on morbidity and survival in colorectal malignancy. Turk J Gastroenterol Off J Turk Soc Gastroenterol 17(4):283–287

    Google Scholar 

  36. Carson JL (1998) Perioperative blood transfusion and postoperative mortality. JAMA 279(3):199

    CAS  PubMed  Google Scholar 

  37. Amar D, Grant FM, Zhang H, Boland PJ, Leung DH, Healey JA (2003) Antifibrinolytic therapy and perioperative blood loss in cancer patients undergoing major orthopedic surgery. Anesthesiology 98(2):337–342

    CAS  PubMed  Google Scholar 

  38. Gonçalves I, Linhares M, Bordin J, Matos D (2009) Artigo original/Original article. Risk factors for indications of among patients undergoing surgical treatment for colorectal adenocarcinoma. Arq Gastroenterol 3:190–193

    Google Scholar 

  39. Frank SM, Savage WJ, Rothschild JA, Rivers RJ, Ness PM, Paul SL, Ulatowski JA (2012) Variability in blood and blood component utilization as assessed by an anesthesia information management system. Anesthesiology 117(1):99–106

    PubMed  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery B, Meir Medical Center, Kfar Saba, Israel

    Yasmin Abu-Ghanem, Hussein Mahajna, Ronen Ghinea, Ian White, Roy Inbar & Shmuel Avital

  2. Assuta Medical Center, Tel Aviv, Israel

    Shmuel Avital

Authors
  1. Yasmin Abu-Ghanem
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  2. Hussein Mahajna
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  3. Ronen Ghinea
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  4. Ian White
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  5. Roy Inbar
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  6. Shmuel Avital
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Corresponding author

Correspondence to Yasmin Abu-Ghanem.

Additional information

Yasmin Abu-Ghanem and Hussein Mahajna contributed equally to this work.

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Abu-Ghanem, Y., Mahajna, H., Ghinea, R. et al. Predictive factors for perioperative blood transfusions in laparoscopic colorectal surgery. Int J Colorectal Dis 29, 723–728 (2014). https://doi.org/10.1007/s00384-014-1854-6

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