Factors influencing perioperative blood transfusions in patients with gastrointestinal cancer.
BACKGROUND
Patients undergoing major cancer resections often receive blood transfusions (TFs). Preoperative erythropoietin (EPO) offers the rationale to reduce TFs and related morbidity.


METHODS
Perioperative TF information was collected prospectively in a single surgeon practice over 5 years.


RESULTS
Three hundred forty-four patients underwent a major procedure, including pancreatic (n = 130, 38%), hepatobiliary (n = 87, 25%), gastroesophageal (n = 69, 20%), and other operations (n = 58, 17%). Median estimated blood loss (EBL) was 375 mL. PRBC TFs were given in 83 cases (24%), at a median of 2 units [1-16]. TF frequency and EBL did not differ between diagnoses. Multivariate TF associations existed for Hgb (P < 0.0001, OR 0.335), EBL (P < 0.0001, OR 1.007), serum Cl (P = 0.004, OR 1.25), serum Na (P = 0.02, OR 0.810), and age (P = 0.04, OR 1.033). TFs (versus no TFs) were linked to major complications (43 versus 20%, P = 0.0002), mortality (12% versus 3%, P = 0.001), and increased LOS (9 versus 7 days, P < 0.0001). A potential benefit for preoperative EPO to avoid TFs could be derived for only 31 patients (9%).


CONCLUSIONS
In this low TF rate of 24% for major visceral resections, few preoperative parameters are able to identify subgroups at risk for TFs aside from blood counts. Our data would not support generalized preoperative EPO administration.
Verma
Varun
V
Division of Surgical Oncology, The Cancer Institute of New Jersey, New Brunswick, New Jersey, USA.
Schwarz
Roderich E
RE
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000517:prevention & control; D001772:Blood Cell Count; D016063:Blood Loss, Surgical / Q000503:physiopathology; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D004921:Erythropoietin / Q000097:blood*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019990:Perioperative Care / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D006454:Hemoglobins; D004921:Erythropoietin