title: Restrictive blood transfusion protocol in liver resection patients reduces blood transfusions with no increase in patient morbidity.
abstract: BACKGROUND
  Management of anemia in surgical oncology patients remains one of the key quality components in overall care and cost. Continued reports demonstrate the effects of hospital transfusion, which has been demonstrated to lead to a longer length of stay, more complications, and possibly worse overall oncologic outcomes. The hypothesis for this study was that a dedicated restrictive transfusion protocol in patients undergoing hepatectomy would lead to less overall blood transfusion with no increase in overall morbidity.
  
  
  METHODS
  A cohort study was performed using our prospective database from January 2000 to June 2013. September 2011 served as the separation point for the date of operation criteria because this marked the implementation of more restrictive blood transfusion guidelines.
  
  
  RESULTS
  A total of 186 patients undergoing liver resection were reviewed. The restrictive blood transfusion guidelines reduced the percentage of patients that received blood from 31.0% before January 9, 2011 to 23.3% after this date (P = .03). The liver procedure that was most consistently associated with higher levels of transfusion was a right lobectomy (16%). Prior surgery and endoscopic stent were the 2 preoperative interventions associated with receiving blood. Patients who received blood before and after the restrictive period had similar predictive factors: major hepatectomies, higher intraoperative blood loss, lower preoperative hemoglobin level, older age, prior systemic chemotherapy, and lower preoperative nutritional parameters (all P < .05). Patients who received blood did not have worse overall progression-free survival or overall survival.
  
  
  CONCLUSIONS
  A restrictive blood transfusion protocol reduces the incidence of blood transfusions and the number of packed red blood cells transfused. Patients who require blood have similar preoperative and intraoperative factors that cannot be mitigated in oncology patients. Restrictive use of blood transfusions can reduce cost and does adversely affect patients undergoing liver resection.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Louisville, 315 E. Broadway #312, Louisville, KY 40202, USA.
authors.forename: John
authors.initials: J
authors.lastname: Wehry
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Louisville, 315 E. Broadway #312, Louisville, KY 40202, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Cannon
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Louisville, 315 E. Broadway #312, Louisville, KY 40202, USA.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Scoggins
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Louisville, 315 E. Broadway #312, Louisville, KY 40202, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Puffer
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Louisville, 315 E. Broadway #312, Louisville, KY 40202, USA.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: McMasters
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Louisville, 315 E. Broadway #312, Louisville, KY 40202, USA. Electronic address: Robert.Martin@louisville.edu.
authors.forename: Robert C G
authors.initials: RC
authors.lastname: Martin
mesh_terms: D000740:Anemia / Q000628:therapy*; D001803:Blood Transfusion / Q000592:standards* / Q000706:statistics & numerical data*; D002985:Clinical Protocols; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Blood transfusion; Complications; Hepatectomy; Liver resection