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Preoperative Transfusion for Anemia in Patients Undergoing Abdominal Surgery for Malignancy

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Transfusion guidelines have been established for severe anemia, but limited data is available regarding the utility of preoperative transfusion. This study evaluates the predictive factors and relative value of preoperative transfusion in oncologic patients with moderate anemia undergoing abdominal surgery.

Methods

Using the American College of Surgeons National Surgical Quality Improvement Program database, adult patients with moderate anemia (hematocrit 21–27%) who underwent non-emergent abdominal oncologic resection from 2005 to 2017 were identified. Preoperative transfusion and non-transfused patients were propensity score matched based on baseline covariates. Outcomes were compared using univariate and Poisson regression analysis.

Results

Of 6222 patients, preoperative transfused (N = 1000, 16.1%) patients were more likely to have bleeding disorders (12.1% vs 6.7%, p < 0.0001) and baseline thrombocytopenia (12% vs 7.3%, p < 0.0001) and had shorter operative length (< 180 min: 69.4% vs 59.8%, p < 0.0001). After matching (N = 987/group), preoperative transfusion was associated with higher rates of intraoperative/postoperative transfusion (odds ratio 1.24, p 0.017) and surgical site infections (odds ratio 1.67, p 0.004) and longer length of stay (incidence rate ratio 1.06, p < 0.0001).

Conclusions

Preoperative transfusion is associated with increased surgical site infections and longer hospital stay and should be carefully considered in oncologic patients given the absence of improvement in outcomes.

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Author information

Authors and Affiliations

  1. Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 5 Silverstein, Philadelphia, PA, 19104, USA

    Adrienne B. Shannon & Yun Song

  2. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Lauren B. Davis Rivera

  3. Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Robert E. Roses, Douglas L. Fraker, Rachel R. Kelz, John T. Miura & Giorgos C. Karakousis

Authors
  1. Adrienne B. Shannon
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  2. Yun Song
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  3. Lauren B. Davis Rivera
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  4. Robert E. Roses
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  5. Douglas L. Fraker
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  6. Rachel R. Kelz
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  7. John T. Miura
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  8. Giorgos C. Karakousis
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Corresponding author

Correspondence to Adrienne B. Shannon.

Additional information

The project was presented as an oral presentation at the 2020 Academic Surgical Congress in Orlando, FL (February 4–6, 2020) and at the 2020 Philadelphia Academy of Surgery conference in Philadelphia, PA (February 11, 2020)

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Shannon, A.B., Song, Y., Davis Rivera, L.B. et al. Preoperative Transfusion for Anemia in Patients Undergoing Abdominal Surgery for Malignancy. J Gastrointest Surg 25, 1534–1544 (2021). https://doi.org/10.1007/s11605-020-04656-w

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  • DOI: https://doi.org/10.1007/s11605-020-04656-w

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