Journal of Gastrointestinal Surgery

, Volume 19, Issue 11, pp 1927–1937 | Cite as

Significant Variation in Blood Transfusion Practice Persists following Upper GI Cancer Resection

  • Christopher T. Aquina
  • Neil Blumberg
  • Christian P. Probst
  • Adan Z. Becerra
  • Bradley J. Hensley
  • James C. Iannuzzi
  • Maynor G. Gonzalez
  • Andrew-Paul Deeb
  • Katia Noyes
  • John R. T. Monson
  • Fergal J. Fleming
Original Article



Perioperative blood transfusions are costly and linked to adverse clinical outcomes. We investigated the factors associated with variation in blood transfusion utilization following upper gastrointestinal cancer resection and its association with infectious complications.


The Statewide Planning and Research Cooperative System was queried for elective esophagectomy, gastrectomy, and pancreatectomy for malignancy in NY State from 2001 to 2013. Bivariate and hierarchical logistic regression analyses were performed to assess the factors associated with receiving a perioperative allogeneic red blood cell transfusion. Additional multivariable analysis examined the relationship between transfusion and infectious complications.


Among 14,875 patients who underwent upper GI cancer resection, 32 % of patients received a perioperative blood transfusion. After controlling for patient, surgeon, and hospital-level factors, significant variation in transfusion rates was present across both surgeons (p < 0.0001) and hospitals (p < 0.0001). Receipt of a blood transfusion was also independently associated with wound infection (OR = 1.68, 95% CI = 1.47 and 1.91), pneumonia (OR = 1.98, 95% CI = 1.74 and 2.26), and sepsis (OR = 2.49, 95% CI = 2.11 and 2.94).


Significant variation in perioperative blood transfusion utilization is present at both the surgeon and hospital level. These findings are unexplained by patient-level factors and other known hospital characteristics, suggesting that variation is due to provider preferences and/or lack of standardized transfusion protocols. Implementing institutional transfusion guidelines is necessary to limit unwarranted variation and reduce infectious complication rates.


Blood transfusion Upper gastrointestinal tract Neoplasms Health services research 


Grant Support



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Copyright information

© The Society for Surgery of the Alimentary Tract 2015

Authors and Affiliations

  • Christopher T. Aquina
    • 1
  • Neil Blumberg
    • 2
  • Christian P. Probst
    • 1
  • Adan Z. Becerra
    • 1
  • Bradley J. Hensley
    • 1
  • James C. Iannuzzi
    • 1
  • Maynor G. Gonzalez
    • 1
  • Andrew-Paul Deeb
    • 1
  • Katia Noyes
    • 1
  • John R. T. Monson
    • 1
  • Fergal J. Fleming
    • 1
  1. 1.Department of Surgery, Surgical Health Outcomes & Research Enterprise (SHORE)University of Rochester Medical CenterRochesterUSA
  2. 2.Department of Pathology and Laboratory MedicineUniversity of Rochester Medical CenterRochesterUSA

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