title: Effect of Intraoperative Red Blood Cell Transfusion on Postoperative Complications After Open Radical Cystectomy: Old Versus Fresh Stored Blood.
abstract: BACKGROUND
  Transfusion with red blood cells (RBCs) is associated with adverse clinical outcomes. We determined whether an intraoperative RBC transfusion is related to postoperative complications in patients undergoing open radical cystectomy. We also compared the effect of transfusion with fresh versus old blood on postoperative complications.
  
  
  METHODS
  A total of 261 patients undergoing open radical cystectomy were divided into no-transfusion or transfusion groups. Transfused patients were divided according to RBC storage duration (fresh, ≤ 14 days; old, > 14 days). Postoperative complications, such as infection, paralytic ileus, urinary tract obstruction, and anastomotic leak, were noted.
  
  
  RESULTS
  Infection (26.5%) was the most common postoperative complication, followed by procedural (17.6%), gastrointestinal (16.7%), renal (13.7%), and vascular (10.5%) problems. Age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.00-1.07; P = .029), urinary diversion with a neobladder (OR, 2.30; 95% CI, 1.29-4.11; P = .005), and intraoperative RBC transfusion (OR, 1.77; 95% CI, 1.02-3.07; P = .042) were independent predictors of postoperative complications in a binary logistic analysis. Patients (n = 172; old blood, n = 47; fresh blood, n = 116; mixed blood, n = 9) who received an intraoperative RBC transfusion had a higher incidence of postoperative complications than those (n = 89) who did not undergo intraoperative transfusion (65.1% vs. 49.4%, P < .05). No difference in the incidence of postoperative complications between transfusions with old blood and fresh blood was observed (63.8% vs. 65.5%).
  
  
  CONCLUSIONS
  Intraoperative RBC transfusion is associated with increased postoperative complications in patients undergoing open radical cystectomy. The RBC storage duration may not affect the incidence of postoperative complications in this study population.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Seung-Jun
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Hyungseok
authors.initials: H
authors.lastname: Seo
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Hyun-Chang
authors.initials: HC
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Seon-Min
authors.initials: SM
authors.lastname: Lim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: So Jeong
authors.initials: SJ
authors.lastname: Yoon
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Hyung Suk
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Ja Hyeon
authors.initials: JH
authors.lastname: Ku
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea. Electronic address: hppark@snu.ac.kr.
authors.forename: Hee-Pyoung
authors.initials: HP
authors.lastname: Park
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D065227:Transfusion Reaction; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Blood storage duration; Blood transfusion; Cystectomy; Postoperative complications