Skip to main content
SpringerLink
Log in

Preoperative predictors of blood transfusion in colorectal cancer surgery

  • Published:
Journal of Gastrointestinal Surgery

Abstract

Transfusion is associated with multiple risks and morbidities. Little is known, however, about preoperative predictors of transfusion in gastrointestinal surgery patients. To identify factors that influence transfusion practices, we analyzed hospital discharge data from colorectal cancer surgery patients in Maryland between 1994 and 2000 (n = 14,052). The primary outcome variable was whether or not patients received a blood product (“Any Transfusion”). Characteristics independently associated with an increased risk of receiving Any Transfusion included: advanced age (>80 yr: OR 2.3; 95% CI 1.9-2.9; 70–79 yr: OR 1.6; 95% CI 1.4-2.0 vs. <60 yr), moderate to severe liver disease (OR 2.5; 95% CI 1.5-4.2), mild liver disease (OR 2.1; 95% CI 1.5-2.9), diabetes with complications (OR 2.1; 95% CI 1.6-2.6), chronic renal disease (OR 2.1; 95% CI 1.4-3.0), female gender (OR 1.3; 95% CI 1.2-1.5), chronic pulmonary disease (COPD) (OR 1.3; 95% CI 1.1-1.4), and metastatic disease (OR 1.2; 95% CI 1.1-1.4). Patients at hospitals with an annual case volume in the highest quartile were at an increased risk for receiving Any Transfusion (OR 2.1; 95% CI 1.3-3.4) and those with surgeons in the highest volume quartile (>12 cases/yr) were at a decreased risk (OR 0.8; 95% CI 0.6-0.99). The association between greater surgeon case volume and low transfusion rates was seen in all but the very high volume hospitals (>74 cases/yr). Blood product transfusion was associated with a 2.5-fold (95% CI 2.1-3.1) increased mortality, 3.7 day (95% CI 2.1-3.1) increase in hospital length of stay, and a $7120 (95% CI $6472-$7769) increase in total charges compared to patients that did not receive Any Transfusion. This data can be used by providers in discussions with patients regarding the risks for transfusion and in identifying patients in whom strategies to reduce transfusions should be evaluated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Goodnough LT, Brecher ME, Kanter MH, AuBuchon JP. Transfusion medicine. First of two parts: Blood transfusion. NEJM 1999;340:438–447.

    Article  PubMed  CAS  Google Scholar 

  2. Consensus conference: Perioperative red blood cell transfusion. JAMA 1988;260:2700-2703.

    Google Scholar 

  3. American College of Physicians. Practice strategies for elective red blood cell transfusion. Ann Intern Med 1992; 116:403–406.

    Google Scholar 

  4. Hebert PC, Wells G, Blajchman M, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. NEJM 1999;340:409–417.

    Article  PubMed  CAS  Google Scholar 

  5. Spahn DR, Casutt M. Eliminating blood transfusions: New aspects and perspectives. Anesthesiology 2000;93(1):242–255.

    Article  PubMed  CAS  Google Scholar 

  6. Carson JL, Altman DG, Duff A, et al. Risk of bacterial infection associated with allogeneic blood transfusion among patients undergoing hip fracture repair. Transfusion 1999; 39:694–700.

    Article  PubMed  CAS  Google Scholar 

  7. Innerhofer P, Walleczek C, Luz G, et al. Transfusion of buffy coat-depleted blood components and risk of postoperative infection in orthopedic patients. Transfusion 1999;39:625–632.

    Article  PubMed  CAS  Google Scholar 

  8. Triulzi DJ, Vanck K, Ryan DH, Blumberg N. A clinical and immunologic study of blood transfusion and postoperative bacterial infection in spinal surgery. Transfusion 1992;32:517–524.

    Article  PubMed  CAS  Google Scholar 

  9. Blumberg N, Heal JM. Blood transfusion immunomodulation: The silent epidemic. Arch Pathol Lab Med 1998; 122:117–119.

    PubMed  CAS  Google Scholar 

  10. Lackritz EM, Satten GA, Aberle-Grasse J, et al. Estimated risk of transmission of the human immunodeficiency virus by screened blood in the United States. N Engl J Med 1995;333:1721–1725.

    Article  PubMed  CAS  Google Scholar 

  11. Kleinman S, Busch MP, Korelitz JJ, Schreiber GB. The incidence/window period model and its use to assess the risk of transfusion-transmitted human immunodeficiency virus and hepatitis C virus infection. Transfus Med Rev 1997;11:155–172.

    Article  PubMed  CAS  Google Scholar 

  12. Vamvakas EC. Transfusion-associated cancer recurrence and postoperative infection: Meta-analysis of randomized, controlled clinical trials. Transfusion 1996;36:175–186.

    Article  PubMed  CAS  Google Scholar 

  13. Kerger H, Waschke KF, Ackern KV, et al. Systemic and microcirculatory effects of autologous whole blood resuscitation in severe hemorrhagic shock. Am J Physiol 1999;276:2035–2043.

    Google Scholar 

  14. Findlay JY, Rettke SR. Poor prediction of blood transfusion requirements in adult liver transplantations from preoperative variables. J Clin Anesth 2000; 12:319–323.

    Article  PubMed  CAS  Google Scholar 

  15. Mariette D, Smadja C, Naveau S, Borgonovo G, Vons C, Franco D. Preoperative predictors of blood transfusion in liver resection for tumor. Am J Surg 1997;173:275–279.

    Article  PubMed  CAS  Google Scholar 

  16. de Andrade JR, Jove M, Landon G, Frei D, et al. Baseline hemoglobin as a predictor of risk of transfusion and response to Epoetin alfa in orthopedic surgery patients. Am J Orthop 1996;25:533–542.

    PubMed  Google Scholar 

  17. Larocque BJ, Gilbert K, Brien WF. A point score system for predicting the likelihood of blood transfusion after hip or knee arthroplasty. Transfusion 1997; 37:463–467.

    Article  PubMed  CAS  Google Scholar 

  18. Keating EM, Meding JB, Faris PM, Ritter MA. Predictors of transfusion risk in elective knee surgery. Clin Orthop 1998;357:50–59.

    Article  PubMed  Google Scholar 

  19. Cirasino L, Barosi G, Torre M, et al. Preoperative predictors of the need for allogeneic blood transfusion in lung cancer surgery. Transfusion 2000;40:1228–1234.

    Article  PubMed  CAS  Google Scholar 

  20. Moscucci M, Ricciardi M, Eagle KA, et al. Frequency, predictors, and appropriateness of blood transfusion after percutaneous coronary interventions. Am J Cardiol 1998;81:702–707.

    Article  PubMed  CAS  Google Scholar 

  21. Nuttall GA, Horlocker TT, Santrach PJ, et al. Predictors of blood transfusion in spinal instrumentation and fusion surgery. Spine 2000;25:596–601.

    Article  PubMed  CAS  Google Scholar 

  22. Pinto GV. Assessment of perioperative blood transfusion in cardiac surgery using administrative data. Transfus Sci 2000; 23:75–81.

    Article  Google Scholar 

  23. Pronovost P, Angus DC. Using large-scale databases to measure outcomes in critical care. Crit Care Clin 1999; 15:615–631.

    Article  PubMed  CAS  Google Scholar 

  24. Schrag D, Cramer LD, Bach PB, et al. Influence of hospital procedure volume on outcomes following surgery for colon cancer. JAMA 2000;284:3028–3035.

    Article  PubMed  CAS  Google Scholar 

  25. Harmon JW, Tang DG, Gordon TA, et al. Hospital volume can serve as a surrogate for surgeon volume for achieving excellent outcomes in colorectal resection. Annals of Surgery 1999;230:404–411.

    Article  PubMed  CAS  Google Scholar 

  26. Department of Labor. Consumer price index-all urban consumers, U.S. city average, medical care 2001. Available at: http:// 146.142.4.24/servlet/SurveyOutputServlet?jrunsessionid = 999526915220170445. Accessed September 3, 2001.

  27. Romano PS, Roos LL, Jollis JG. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: Differing Perspectives. J Clin Epidemiol 1993;46:1075–1079.

    Article  PubMed  CAS  Google Scholar 

  28. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method for classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis 1987;40:373–383.

    Article  PubMed  CAS  Google Scholar 

  29. Paterson L, Goldstein H. New statistical methods for analyzing social structures: An introduction to multilevel models. Br Educ Res J 1991;17:387–393.

    Article  Google Scholar 

  30. Cleveland WS. Robust locally weighted regression and smoothing scatterplots. J Am stat Assoc. 1979;74:829–836.

    Article  Google Scholar 

  31. Pronovost PJ, Jenckes M, Dorman T, et al. Organizational characteristics of intensive care units related to outcomes of abdominal aortic surgery. JAMA 1999;281:1310–1312.

    Article  PubMed  CAS  Google Scholar 

  32. Berenholtz SM, Pronovost PJ, Mullany D, et al. Predictors of transfusion for spinal surgery in Maryland, 1997–2000. Transfusion 2002;42:183–189.

    Article  PubMed  Google Scholar 

  33. Segal JB, Ness PM, Powe NR. Validating billing data for RBC transfusions: Abrief report. Transfusion 2001;41:530–533.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology/CCM, The Johns Hopkins University Schools of Medicine and Hygiene and Public Health, Baltimore, Maryland

    Kent R. Nilsson M.A., Sean M. Berenholtz M.D., Todd Dorman M.D., Pamela Lipsett M.D. & Peter J. Pronovost M.D., Ph.D.

  2. Department of Surgery, The Johns Hopkins University Schools of Medicine and Hygiene and Public Health, Baltimore, Maryland

    Sean M. Berenholtz M.D., Todd Dorman M.D., Pamela Lipsett M.D., Howard S. Kaufman M.D. & Peter J. Pronovost M.D., Ph.D.

  3. Department of Medicine, The Johns Hopkins University Schools of Medicine and Hygiene and Public Health, Baltimore, Maryland

    Todd Dorman M.D.

  4. Department of Oncology, The Johns Hopkins University Schools of Medicine and Hygiene and Public Health, Baltimore, Maryland

    Elizabeth Garrett Ph.D.

  5. Department of Health Policy and Management, The Johns Hopkins University Schools of Medicine and Hygiene and Public Health, Baltimore, Maryland

    Peter J. Pronovost M.D., Ph.D.

Authors
  1. Kent R. Nilsson M.A.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sean M. Berenholtz M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Todd Dorman M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elizabeth Garrett Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pamela Lipsett M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Howard S. Kaufman M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Peter J. Pronovost M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sean M. Berenholtz M.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nilsson, K.R., Berenholtz, S.M., Dorman, T. et al. Preoperative predictors of blood transfusion in colorectal cancer surgery. J Gastrointest Surg 6, 753–762 (2002). https://doi.org/10.1016/S1091-255X(02)00043-4

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1016/S1091-255X(02)00043-4

Key words

Search

Navigation