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Perioperative Blood Transfusion and Postoperative Outcome in Patients with Crohn’s Disease Undergoing Primary Ileocolonic Resection in the “Biological Era”

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Perioperative blood transfusion has been shown to be associated with inflammatory response and immunosuppression. Patients receiving blood transfusion may have an increased risk for developing postoperative morbidities. The impact of blood transfusion on the postoperative recurrence of Crohn’s disease (CD) has been controversial. The aim of this study was to assess the effect of blood transfusion on postoperative outcomes in CD in the current biological era.

Methods

This historical cohort study involved data collection and analysis of CD patients who underwent the index ileocolonic resection in our institution between 2000 and 2012. Postoperative complications were compared between the transfused and nontransfused patients. The effects of perioperative blood transfusion on postoperative complications and disease recurrence were analyzed with both univariate and multivariate analyses.

Results

A total of 318 patients were included in the study, and 52 of them (16.5 %) received perioperative blood transfusion. Blood transfusion was found to be associated with an increased risk of postoperative infectious and noninfectious complications both in univariate (P < 0.001 for each) and multivariable analyses (infectious complications: odds ratio [OR] = 8.73, 95 % confidence interval [CI] 2.85–26.78, P < 0.001; noninfectious complications: OR = 3.64, 95 % CI 1.30–10.18; P = 0.014). In addition, the Cox regression model indicated that blood transfusion was associated with both surgical (hazard ratio [HR] = 3.43, 95 % CI 1.92–6.13; P < 0.001) and endoscopic (HR = 2.08, 95 % CI 1.38–3.14; P < 0.001) CD recurrence following the index surgery.

Conclusion

Adverse outcomes after perioperative blood transfusion for the primary ileocolonic resection for CD resemble findings in surgery for other diseases. The presumed immunosuppressive effect of blood transfusion did not confer any protective effect on disease recurrence.

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Abbreviations

ASA:

American Society of Anesthesiologists

BMI:

Body mass index

CD:

Crohn’s disease

CI:

Confidence interval

EBL:

Estimated blood loss

EIM:

Extra-intestinal manifestations

HR:

Hazard ratio

IBD:

Inflammatory bowel disease

ICR:

Ileocolonic resection

OR:

Odds ratio

SBO:

Small bowel obstruction

SD:

Standard deviation

SSI:

Surgical site infection

TNF:

Tumor-necrosis factor

UTI:

Urinary tract infection

WBC:

White blood cell

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Acknowledgments

Yi Li, M.D. Ph.D. is a research fellow from Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China. Dr. Bo Shen is supported by the Ed and Joey Story Endowed Chair.

Conflicts of interest

The authors declared no financial conflict of interest.

Author contributions

YL, YR, and GL contributed to study concept and design, acquisition, analysis and interpretation of data, and drafting of the manuscript. YL and YR contributed to analysis and interpretation of data, and manuscript review. LS, EG, FR, and BS contributed to study concept and design, interpretation of data, and critical revision of the manuscript for important intellectual content. LS, FR, and BS supervised the study. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. Department of Colorectal Surgery, the Cleveland Clinic Foundation, Cleveland, OH, USA

    Yi Li, Luca Stocchi, Yuanyi Rui, Ganglei Liu, Emre Gorgun & Feza H. Remzi

  2. Department of Gastroenterology/Hepatology, the Cleveland Clinic Foundation, Cleveland, OH, USA

    Bo Shen

  3. Center for Inflammatory Bowel Disease, Digestive Disease Institute, Desk A31, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Bo Shen

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  1. Yi Li
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Li, Y., Stocchi, L., Rui, Y. et al. Perioperative Blood Transfusion and Postoperative Outcome in Patients with Crohn’s Disease Undergoing Primary Ileocolonic Resection in the “Biological Era”. J Gastrointest Surg 19, 1842–1851 (2015). https://doi.org/10.1007/s11605-015-2893-1

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