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Declining Use of Red Blood Cell Transfusions for Gastrointestinal Cancer Surgery: A Population-Based Analysis

  • Health Services Research and Global Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Gastrointestinal cancer surgery patients often develop perioperative anemia commonly treated with red blood cell (RBC) transfusions. Given the potential associated risks, evidence published over the past 10 years supports restrictive transfusion practices and blood conservation programs. Whether transfusion practices have changed remains unclear. We describe temporal RBC transfusion trends in a large North American population who underwent gastrointestinal cancer surgery.

Methods

We conducted a population-based retrospective cohort study of patients who underwent gastrointestinal cancer resection between 2007 and 2018 using health administrative datasets. The outcome was RBC transfusion during hospitalization. Temporal transfusion trends were analyzed with Cochran-Armitage tests. Multivariable regression assessed the association between year of diagnosis and likelihood of RBC transfusion while controlling for confounding.

Results

Of 79,764 patients undergoing gastrointestinal cancer resection, the median age was 69 years old (interquartile range (IQR) 60–78 years) and 55.5% were male. The most frequent procedures were colectomy (52.8%) and proctectomy (23.0%). A total of 18,175 patients (23%) received RBC transfusion. The proportion of patients transfused decreased from 26.5% in 2007 to 18.9% in 2018 (p < 0.001). After adjusting for patient, procedure, and hospital factors, the most recent time period (2015–2018) was associated with a reduced likelihood of receiving RBC transfusion [relative risk 0.86 (95% confidence interval: 0.83–0.89)] relative to the intermediate time period (2011–2014).

Conclusion

Over 11 years, we observed decreased RBC transfusion use and reduced likelihood of transfusion in patients undergoing gastrointestinal cancer resection. This information provides a foundation to further examine transfusion appropriateness or explore if additional transfusion minimization in surgical patients can be achieved.

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Acknowledgments

We thank the Ontario Regional Blood Coordinating Network (ORBCoN) and the Ontario Transfusion Coordinators (ONTraC) program for their support. This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Parts of this material are based on data and/or information compiled and provided by CIHI. However, the analyses, conclusions, opinions, and statements expressed in the material are those of the author(s), and not necessarily those of CIHI. Parts of this material are based on data and information provided by Cancer Care Ontario (CCO). The opinions, results, view, and conclusions reported in this paper are those of the authors and do not necessarily reflect those of CCO. No endorsement by CCO is intended or should be inferred. Parts of this work were presented at American Society of Clinical Oncology Gastrointestinal Cancer Symposium, San Francisco, CA, January 23, 2020; University of Toronto Department of Surgery Gallie Day, Toronto, Canada, May 8, 2020; University of Toronto Division of General Surgery Annual Assembly, Toronto, Canada, May 14, 2020.

Funding

This study received funding from the following: Ministry of Health and Long-Term Care Clinician Investigator Program, Sunnybrook Alternative Funding Plan Innovation Grant, and Canadian Institute of Health Research New Investigator Award. The funding sources had no role in the design and conduct of the study.

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Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada

    Jesse Zuckerman MDCM, Natalie Coburn MD, MPH & Julie Hallet MD, Msc

  2. Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada

    Jesse Zuckerman MDCM, Natalie Coburn MD, MPH & Julie Hallet MD, Msc

  3. Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada

    Natalie Coburn MD, MPH & Julie Hallet MD, Msc

  4. Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada

    Natalie Coburn MD, MPH, Victoria Zuk MSc & Julie Hallet MD, Msc

  5. Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada

    Jeannie Callum MD, MSc & Yulia Lin MD

  6. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada

    Jeannie Callum MD, MSc & Yulia Lin MD

  7. Department of Community Health Sciences, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada

    Alyson L. Mahar PhD

  8. Department of Surgery, University of Toronto, Toronto, Canada

    Robin McLeod MD & Emily Pearsall MSc

  9. CHU de Québec – Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Université Laval, Québec City, Canada

    Alexis F. Turgeon MD, MSc

  10. Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Université Laval, Québec City, Canada

    Alexis F. Turgeon MD, MSc

  11. ICES, Toronto, Canada

    Haoyu Zhao MPH

  12. Department of Surgery, University of Ottawa, Ottawa, Canada

    Guillaume Martel MD, MSc

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  1. Jesse Zuckerman MDCM
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  2. Natalie Coburn MD, MPH
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  11. Guillaume Martel MD, MSc
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  12. Julie Hallet MD, Msc
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Correspondence to Julie Hallet MD, Msc.

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The authors declare no relevant conflicts of interest. J.C. has received research support from Canadian Blood Services and Octapharma. Y.L. has received research support from Novartis and Octapharma, and has consulted for Amgen and Pfizer. J.H. has received speaking honoraria from Ipsen Biopharmaceuticals Canada and Advanced Accelerator Applications.

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Zuckerman, J., Coburn, N., Callum, J. et al. Declining Use of Red Blood Cell Transfusions for Gastrointestinal Cancer Surgery: A Population-Based Analysis. Ann Surg Oncol 28, 29–38 (2021). https://doi.org/10.1245/s10434-020-09291-y

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