title: Preoperative hypoalbuminemia and anemia as predictors of transfusion in radical nephrectomy for renal cell carcinoma: a retrospective study.
abstract: BACKGROUND
  The only curative therapy for renal cell carcinoma is the complete removal of malignant tissue. Surgical bleeding during radical nephrectomy may require blood transfusion. Blood transfusion, however, is associated with postoperative morbidity and mortality. This study investigated predictive factors of transfusion requirement in patients undergoing radical nephrectomy, as well as the effects of transfusion on postoperative outcomes.
  
  
  METHODS
  This study retrospectively enrolled 526 patients who underwent open radical nephrectomy for renal cell carcinoma between 2010 and 2012. Univariate and multivariate logistic regression analyses were used to determine independent predictive factors of a requirement for packed red blood cell (PRBC) transfusion. Postoperative outcomes included an admission to the intensive care unit (ICU) and lengths of ICU and hospital stay.
  
  
  RESULTS
  Of the 526 patients, 93 (17.7 %) required PRBC transfusion, with these patients requiring a mean 5.5 units. Preoperative hypoalbuminemia (serum albumin <3.5 g/dL) was observed in 75 (14.3 %) patients, and preoperative anemia (hemoglobin <12.0 g/dL) in 121 (23.0 %). Multivariate logistic regression analysis showed that preoperative hypoalbuminemia, preoperative anemia, and a high cancer stage were independent factors significantly associated with PRBC transfusion in open radical nephrectomy. The transfused group had higher incidence of ICU admission and longer lengths of ICU and hospital stay than the non-transfused group.
  
  
  CONCLUSIONS
  Preoperative hypoalbuminemia and anemia are important predictors of PRBC transfusion during radical nephrectomy for renal cell carcinoma. Furthermore, transfusion is associated with poor postoperative outcomes.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Kyungmi
authors.initials: K
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Hyungseok
authors.initials: H
authors.lastname: Seo
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Ji-Hyun
authors.initials: JH
authors.lastname: Chin
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Hyo-Jung
authors.initials: HJ
authors.lastname: Son
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Jai-Hyun
authors.initials: JH
authors.lastname: Hwang
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea. kyk@amc.seoul.kr.
authors.forename: Young-Kug
authors.initials: YK
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000150:complications; D016063:Blood Loss, Surgical; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000150:complications; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007680:Kidney Neoplasms / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D057234:Preoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome