title: Blood transfusions in colorectal cancer surgery: incidence, outcomes, and predictive factors: an American College of Surgeons National Surgical Quality Improvement Program analysis.
abstract: BACKGROUND
  Data analyzing the short-term outcomes and predictors of blood transfusions (BTs) in colorectal cancer (CRC) surgery are limited.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program (2005 to 2010) was retrospectively reviewed for CRC cases performed with or without BT. Patient demographics, comorbidities, and operative variables were analyzed. Multivariate regression analysis was performed examining the effect of BT on outcomes. The LASSO algorithm for logistic regression was used to build a predictive model for BT taking into account preoperative and operative variables.
  
  
  RESULTS
  A total of 27,120 patients underwent CRC, and 3,815 (14.07%) had BTs. Transfusions were associated with increased mortality (odds ratio [OR], 1.78), morbidity (OR, 2.38), length of stay (mean difference, 3.52 days), pneumonia (OR, 2.70), and surgical-site infection (OR, 1.45). This effect was "dose dependent," as patients receiving ≥3 U of blood had increased morbidity (OR, 1.53), lengths of stay (mean difference, 1.82 days), pneumonia (OR, 2.52), and surgical-site infections (OR, 1.60) compared with those receiving 1 to 2 U. Predictors of BT were hematocrit <38%, open surgery, proctectomy, low platelet count, American Society of Anesthesiologists class IV or V, total colectomy, metastatic cancer, emergency, ascites, and infection. All P values were < .05.
  
  
  CONCLUSIONS
  BTs are associated with worse short-term outcomes after CRC surgery. Knowledge of predictive factors will help in risk stratification and counseling.
authors.affiliation: Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd West, Suite 700, Orange, CA 92868, USA.
authors.forename: Wissam J
authors.initials: WJ
authors.lastname: Halabi
authors.forename: Mehraneh D
authors.initials: MD
authors.lastname: Jafari
authors.forename: Vinh Q
authors.initials: VQ
authors.lastname: Nguyen
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Carmichael
authors.forename: Steven
authors.initials: S
authors.lastname: Mills
authors.forename: Alessio
authors.initials: A
authors.lastname: Pigazzi
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stamos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D003082:Colectomy / Q000592:standards*; D015179:Colorectal Neoplasms / Q000601:surgery*; D003107:Colorectal Surgery / Q000592:standards* / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D058996:Quality Improvement; D012189:Retrospective Studies; D012955:Societies, Medical; D014481:United States
keywords: Blood transfusions; Colorectal cancer; NSQIP; Outcomes; Predictive factors