Transfusion requirements in surgical oncology patients: a prospective, randomized controlled trial.
BACKGROUND
Several studies have indicated that a restrictive erythrocyte transfusion strategy is as safe as a liberal one in critically ill patients, but there is no clear evidence to support the superiority of any perioperative transfusion strategy in patients with cancer.


METHODS
In a randomized, controlled, parallel-group, double-blind (patients and outcome assessors) superiority trial in the intensive care unit of a tertiary oncology hospital, the authors evaluated whether a restrictive strategy of erythrocyte transfusion (transfusion when hemoglobin concentration <7 g/dl) was superior to a liberal one (transfusion when hemoglobin concentration <9 g/dl) for reducing mortality and severe clinical complications among patients having major cancer surgery. All adult patients with cancer having major abdominal surgery who required postoperative intensive care were included and randomly allocated to treatment with the liberal or the restrictive erythrocyte transfusion strategy. The primary outcome was a composite endpoint of mortality and morbidity.


RESULTS
A total of 198 patients were included as follows: 101 in the restrictive group and 97 in the liberal group. The primary composite endpoint occurred in 19.6% (95% CI, 12.9 to 28.6%) of patients in the liberal-strategy group and in 35.6% (27.0 to 45.4%) of patients in the restrictive-strategy group (P = 0.012). Compared with the restrictive strategy, the liberal transfusion strategy was associated with an absolute risk reduction for the composite outcome of 16% (3.8 to 28.2%) and a number needed to treat of 6.2 (3.5 to 26.5).


CONCLUSIONS
A liberal erythrocyte transfusion strategy with a hemoglobin trigger of 9 g/dl was associated with fewer major postoperative complications in patients having major cancer surgery compared with a restrictive strategy.
From the Surgical Intensive Care Unit and Department of Anesthesiology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (J.P.d.A., F.R.B.G.G., E.P.M.d.A., J.T.F., E.A.O., F.B., C.L.P., R.E.N., S.M.R.F., J.I.A., M.B., S.V., A.C.V.S., H.P., R.K.F., J.O.C.A., L.A.H.); Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium (J.-L.V.); Department of Intensive Care Medicine, St. George's Healthcare NHS Trust, London, United Kingdom (A.R.); Department of Surgery, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (G.C., U.R., A.C., M.D.); and Department of Oncology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (M.d.P.E.D.).
Juliano Pinheiro
JP
de Almeida
Jean-Louis
JL
Vincent
Filomena Regina Barbosa Gomes
FR
Galas
Elisangela Pinto Marinho
EP
de Almeida
Julia T
JT
Fukushima
Eduardo A
EA
Osawa
Fabricio
F
Bergamin
Clarice Lee
CL
Park
Rosana Ely
RE
Nakamura
Silvia M R
SM
Fonseca
Guilherme
G
Cutait
Joseane Inacio
JI
Alves
Mellik
M
Bazan
Silvia
S
Vieira
Ana C Vieira
AC
Sandrini
Henrique
H
Palomba
Ulysses
U
Ribeiro
Alexandre
A
Crippa
Marcos
M
Dalloglio
Maria del Pilar Estevez
Mdel P
Diz
Roberto
R
Kalil Filho
Jose Otavio Costa
JO
Auler
Andrew
A
Rhodes
Ludhmila Abrahao
LA
Hajjar
D000008:Abdominal Neoplasms / Q000601:surgery*; D001938:Brazil / Q000453:epidemiology; D004311:Double-Blind Method; D017707:Erythrocyte Transfusion / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012306:Risk
D006454:Hemoglobins