Original Article

Journal of Gastrointestinal Surgery

, Volume 18, Issue 4, pp 719-728

Trends and Risk Factors for Transfusion in Hepatopancreatobiliary Surgery

  • Donald J. LucasAffiliated withDepartment of Surgery, Walter Reed National Military Medical Center
  • , Katherine I. SchexneiderAffiliated withDepartment of Pathology, Uniformed Services University of the Health Sciences
  • , Matthew WeissAffiliated withDepartment of Surgery, The Johns Hopkins University School of Medicine
  • , Christopher L. WolfgangAffiliated withDepartment of Surgery, The Johns Hopkins University School of Medicine
  • , Steven M. FrankAffiliated withDepartment of Anesthesiology/Critical Care Medicine, The Johns Hopkins University School of Medicine
  • , Kenzo HiroseAffiliated withDepartment of Surgery, The Johns Hopkins University School of Medicine
  • , Nita AhujaAffiliated withDepartment of Surgery, The Johns Hopkins University School of Medicine
  • , Martin MakaryAffiliated withDepartment of Surgery, The Johns Hopkins University School of Medicine
  • , John L. CameronAffiliated withDepartment of Surgery, The Johns Hopkins University School of MedicineDivision of Surgical Oncology, John Hopkins Hospital
    • , Timothy M. PawlikAffiliated withDepartment of Surgery, The Johns Hopkins University School of MedicineDivision of Surgical Oncology, John Hopkins Hospital Email author 

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Abstract

Introduction

Patient-specific factors impacting the need for possible perioperative blood transfusions have not been examined in patients undergoing hepatopancreatobiliary (HPB) procedures. We sought to define the overall utilization of blood transfusions for HPB surgery stratified by procedure type, as well as identify patient-level risk factors for transfusion.

Methods

Hepatic and pancreatic resections were selected from the 2005–2011 American College of Surgeons National Surgical Quality Improvement Program's public use files. Transfusion utilization, risk factors, temporal trends, and outcomes were assessed using regression models. Missing data were addressed using multiple imputation.

Results

Twenty-six thousand eight hundred twenty-seven patients met the inclusion criteria. There were 16,953 pancreas cases (distal pancreatectomy (31.2 %), pancreaticoduodenectomy (65.8 %), total pancreatectomy (3.0 %)), and 9,874 liver cases (wedge resection (60.0 %), hemi-hepatectomy (30.1 %), trisegmentectomy (9.9 %)). Overall, 25.7 % patients received a perioperative transfusion. Transfusion rates varied by operation type (hepatic wedge resection 18.7 %, lobectomy 31.3 %, trisegmentectomy 39.8 %, distal pancreatectomy 19.8 %, Whipple 28.7 %, total pancreatectomy 43.6 %, p < 0.001). On multivariate analysis, several patient-level factors were strongly associated with the risk of transfusion: preoperative hematocrit <36 % (risk ratios (RR) 1.99, 95 % CI 1.91–2.08), preoperative albumin <3.0 g/dL (RR 1.25, 95 % CI 1.19–1.31), American Society of Anesthesiologists (ASA) class IV (RR 1.24, 95 % CI 1.16–1.33), and anticoagulation/bleeding disorder (RR 1.26, 95 % CI 1.15–1.38) (all p < 0.001). Patients with any one of these high-risk factors had an over twofold increased risk of perioperative transfusion (RR 2.31, 95 % CI 2.21–2.40, p < 0.001).

Conclusion

There are large differences in the incidence of transfusion among patients undergoing HPB procedures. While the type of HPB procedure was associated with the risk of transfusion, patient-level factors—including preoperative hematocrit and albumin, ASA classification, and history of anticoagulation/bleeding disorder—were as important.

Keywords

Transfusion HPB Surgery Pancreas Liver