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Peri-operative allogeneic blood transfusion and outcomes after radical cystectomy: a population-based study

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Abstract

Introduction

To describe factors associated with peri-operative blood transfusion (PBT) at radical cystectomy (RC) for patients with bladder cancer and evaluate its association on both early and late outcomes.

Methods

Electronic records of treatment and surgical pathology reports were linked to the population-based Ontario Cancer Registry to identify all patients who underwent RC between 2000 and 2008. Modified Poisson regression model was used to determine the factors associated with PBT. A Cox-proportional hazards regression model was used to explore the association between PBT and overall (OS) and cancer-specific (CSS) survival.

Results

Among 2593 patients identified, 62% received an allogeneic red blood cell transfusion. The frequency of PBT decreased over the study period (from 68 to 54%, p < 0.001). Factors associated with PBT included age, sex, greater co-morbidity, stage, and surgeon volume. PBT was associated with inferior outcomes, including median length of stay (11 vs. 9 days, p < 0.001), 90-day re-admission rate (38 vs. 29%, p < 0.001), and mortality (11 vs. 4%, p < 0.001). OS and CSS at 5 years were lower among patients with PBT on multivariate analysis (OS HR 1.33, 95% CI 1.20–1.48; CSS HR 1.39, 95% CI 1.23–1.56).

Conclusions

Although rates are decreasing, these data suggest a very high utilization rate of PBT at time of RC in routine clinical practice. PBT is associated with substantially worse early outcomes and long-term survival. This association persists despite adjustment for disease-, patient-, and provider-related factors, suggesting that PBT is an important indicator of surgical care of RC.

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References

  1. Leveridge MJ, Siemens DR, Mackillop WJ et al (2015) Radical cystectomy and adjuvant chemotherapy for bladder cancer in the elderly: a population-based study. Urology 85(4):791–798

    Article  PubMed  Google Scholar 

  2. Stein JP, Lieskovsky G, Cote R et al (2001) Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol 1 19(3):666–675

    Article  CAS  Google Scholar 

  3. Gandaglia G, Varda B, Sood A et al (2014) Short-term perioperative outcomes of patients treated with radical cystectomy for bladder cancer included in the National Surgical Quality Improvement Program (NSQIP) database. Can Urol Assoc J 8(9–10):E681–E687

    Article  PubMed  PubMed Central  Google Scholar 

  4. Siemens DR, Mackillop WJ, Peng Y et al (2014) Processes of care and the impact of surgical volumes on cancer-specific survival: a population-based study in bladder cancer. Urology 84(5):1049–1057

    Article  PubMed  Google Scholar 

  5. Hallet J, Tsang M, Cheng ESW et al (2015) The impact of perioperative red blood cell transfusions on long-term outcomes after hepatectomy for colorectal liver metastases. Ann Surg Oncol 22:4038–4045

    Article  PubMed  Google Scholar 

  6. Murphy GJ, Barnaby C, Reeves BC et al (2007) Increased mortality, postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery. Circulation 116:2544–2552

    Article  PubMed  Google Scholar 

  7. Chander AS, Goodnough LT (2010) Blood transfusion as a quality indicator in cardiac surgery. JAMA 304:1610–1611

    Article  Google Scholar 

  8. Dixon E, Datta I, Sutherland FR et al (2009) Blood loss in surgical oncology: neglected quality indicator? J Surg Oncol 99:508–512

    Article  PubMed  Google Scholar 

  9. Hill GE, Frawley WH, Griffith KE et al (2003) Allogenic blood transfusion increases the risk of postoperative bacterial infection: a meta-analysis. J Trauma 54:908–914

    Article  PubMed  Google Scholar 

  10. Agarwal N, Murphy JG, Cayten CG et al (1993) Blood transfusion increases the risk of infection after trauma. Arch Surg 128:171–177

    Article  CAS  PubMed  Google Scholar 

  11. Ball CG, Pitt HA, Kilbane ME et al (2010) Peri-operative blood transfusion and operative time are quality indicators for pancreatoduodenectomy. HPB†¯ Off J Int Hepato Pancreato Biliary Assoc 12(7):465–471

    Article  Google Scholar 

  12. McAlister FA, Clark HD, Wells PS et al (2001) Perioperative allogenic blood transfusion does not cause adverse sequelae in patients with cancer: a meta-analysis of unconfounded studies. Br J Surg 85:171–178

    Article  Google Scholar 

  13. Busch OR, Hop WC, Marquet RL et al (1994) Blood transfusions and local tumor recurrence in colorectal cancer: evidence of a noncausal relationship. Ann Surg 220:791–797

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Crowe JP, Gordon NH, Fry DE et al (1989) Breast cancer survival and perioperative blood transfusion. Surgery 106:836–841

    CAS  PubMed  Google Scholar 

  15. Amato A, Pescatori M. Perioperative blood transfusions for the recurrence of colorectal cancer. Cochrane Database Syst Rev. 25;(1):CD 005033, 2006.

  16. Albisinni S, Oderda M, Fossion L et al (2016) The morbidity of laparoscopic radical cystectomy: analysis of postoperative complications in a multicenter cohort by the European Association of Urology (EAU)-Section of Uro-Technology. World J Urol 34:149–156

    Article  PubMed  Google Scholar 

  17. Ng CK, Kauffman EC, Lee M-M et al (2010) A comparison of postoperative complications in open versus robotic cystectomy. Eur Urol 57:274–282

    Article  PubMed  Google Scholar 

  18. Sadeghi N, Badalato GM, Hruby G et al (2012) The impact of perioperative blood transfusion on survival following radical cystectomy for urothelial carcinoma. Can J Urol 19(5):6443–6449

    PubMed  Google Scholar 

  19. Linder BJ, Frank I, Cheville JC et al (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 

  20. Abel JE, Linder BL, Bauman TM et al (2014) Perioperative blood transfusion and radical cystectomy: does timing of transfusion affect bladder cancer mortality? Eur Urol 66(6):1139–1147

    Article  PubMed  Google Scholar 

  21. Moschini M, Dell’ Oglio P, Capogrosso P et al (2015) Effect of allogeneic intraoperative blood transfusion on survival in patients treated with radical cystectomy for nonmetastatic bladder cancer: results from a single high-volume institution. Clin Genitourin Cancer 13(6):562–567

    Article  PubMed  Google Scholar 

  22. Kluth LA, Xylinas E, Rieken M et al (2014) Impact of peri-operative blood transfusion on the outcomes of patients undergoing radical cystectomy for urothelial carcinoma of the bladder. BJU Int 113(3):393–398

    Article  PubMed  Google Scholar 

  23. Jahnson S, Bergström R, Pedersen J (1994) Extent of blood transfusion and cancer-related mortality after cystectomy and urinary diversion for bladder cancer. Br J Urol 74(6):779–784

    Article  CAS  PubMed  Google Scholar 

  24. Clarke EA, Marrett LD, Krieger N (1991) Cancer registration in Ontario: A computer approach. In: Jenson OM, Parkin DM, MacLennan R (eds) Cancer registration principles and methods. IARC, Lyon, pp 246–257

    Google Scholar 

  25. Williams J, Young W (1996) A summary of studies on the quality of health care administrative databases in Canada. In: Goel V, Williams JI, Anderson GM et al (eds) Patterns of health care in Ontario: The ICES Practice Atlas, 339–345. Canadian Medical Association, Ottawa

    Google Scholar 

  26. Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45:613–619

    Article  CAS  PubMed  Google Scholar 

  27. Hopewell S, Omar O, Hyde C et al (2013) A systematic review of the effect of red blood cell transfusion on mortality: evidence from large-scale observational studies published between 2006 and 2010. BMJ Open 3:e002154. doi:10.1136/bmjopen-2012-002154

    Article  PubMed  PubMed Central  Google Scholar 

  28. Vamvakas EC (2011) Establishing causation in transfusion medicine and related tribulations. Transfus Med Rev 25:81–88

    Article  PubMed  Google Scholar 

  29. Liu L, Wang Z, Jiang S et al (2013) Perioperative allogenenic blood transfusion is associated with worse clinical outcomes for hepatocellular carcinoma: a meta-analysis. PloS one 8(5):e64261

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Wang Y-L, Jiang B, Yin F-F et al (2015) perioperative blood transfusion promotes worse outcomes of bladder cancer after radical cystectomy: a systematic review and meta-analysis. PLoS One 10(6):e0130122

    Article  PubMed  PubMed Central  Google Scholar 

  31. Ferraris VA, Davenport DL, Saha SP et al (2012) Surgical outcomes and transfusion of minimal amounts of blood in the operating room. Arch Surg 147(1):49–55

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This research was supported by Cancer Care Ontario. Dr. Booth holds a Cancer Care Ontario Chair in Health Services Research. Parts of this material are based on data and information provided by Cancer Care Ontario. However, the analysis, conclusions, opinions, and statements expressed herein are those of the authors and not necessarily those of Cancer Care Ontario. This study was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred.

Author contributions

DRS: protocol/project development, data analysis, manuscript writing/editing. MJ: data analysis, manuscript writing/editing. XW: data collection or management, data analysis, manuscript writing/editing. FVB: data analysis, manuscript writing/editing. CB: protocol/project development, data collection or management, data analysis, manuscript writing/editing. All the authors have made a significant contribution to the preparation of this document. It has not been previously published nor is it in consideration for publication elsewhere.

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Authors and Affiliations

  1. Department of Urology, Kingston General Hospital, Queen’s University, Victory 4, 76 Stuart St., Kingston, ON, K7L 2V7, Canada

    D. Robert Siemens

  2. Department of Oncology, Queen’s University, Kingston, Canada

    D. Robert Siemens, Francisco Vera-Badillo & Christopher M. Booth

  3. Department of Anesthesiology and Perioperative Medicine, Queen’s University, Kingston, Canada

    Melanie T. Jaeger

  4. Division of Cancer Care and Epidemiology, Queen’s University Cancer Research Institute, Kingston, Canada

    Xuejiao Wei & Christopher M. Booth

Authors
  1. D. Robert Siemens
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  2. Melanie T. Jaeger
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  3. Xuejiao Wei
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  4. Francisco Vera-Badillo
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  5. Christopher M. Booth
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Corresponding author

Correspondence to D. Robert Siemens.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Conflict of interest

None of the authors have a conflict of interest with the publication of this study.

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Siemens, D.R., Jaeger, M.T., Wei, X. et al. Peri-operative allogeneic blood transfusion and outcomes after radical cystectomy: a population-based study. World J Urol 35, 1435–1442 (2017). https://doi.org/10.1007/s00345-017-2009-5

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  • DOI: https://doi.org/10.1007/s00345-017-2009-5

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