title: The impact of an integrated transfusion reduction initiative in patients undergoing resection for colorectal cancer.
abstract: BACKGROUND
  Perioperative blood transfusions in patients with colorectal cancer are associated with increased cost, morbidity, mortality and decreased survival. In 2009, a 3-part transfusion reduction initiative (TRI) was introduced. The hypothesis was that this would decrease transfusions without increasing complications in patients undergoing elective resection for colorectal cancer.
  
  
  METHODS
  After institutional review board approval was obtained, the medical records of patients who underwent colon resection before (January 2006 to October 2009) and after (November 2009 to March 2011) the TRI were reviewed.
  
  
  RESULTS
  Three hundred sixty-eight patients were included, 272 and 96 in the pre-TRI and post-TRI groups, respectively. Transfusion rates decreased in the post-TRI group compared with the pre-TRI group (15% vs 28%, P = .011). Median postoperative hemoglobin levels among transfused patients were 8.4 and 7.3 g/dL in the pre-TRI and post-TRI groups, respectively (P = .009). There was no difference in complications or 30-day mortality. Transfused patients with stages I to III adenocarcinoma had worse 4-year survival (P < .05).
  
  
  CONCLUSIONS
  Perioperative transfusions in colorectal cancer surgery decreased after the implementation of a TRI. Complication rates did not change. Perioperative transfusions were associated with worse survival in patients with stages I to III cancer.
authors.affiliation: Department of Medical Education, Gundersen Lutheran Medical Foundation, La Crosse, WI, USA.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Froman
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Mathiason
authors.forename: Kara J
authors.initials: KJ
authors.lastname: Kallies
authors.forename: Wayne A
authors.initials: WA
authors.lastname: Bottner
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Shapiro
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000592:standards / Q000706:statistics & numerical data*; D003082:Colectomy / Q000401:mortality; D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery*; D003661:Decision Support Techniques; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D019990:Perioperative Care / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D015397:Program Evaluation; D012189:Retrospective Studies