Perioperative Blood Transfusion and Postoperative Outcome in Patients with Crohn's Disease Undergoing Primary Ileocolonic Resection in the "Biological Era".
BACKGROUND
Perioperative blood transfusion has been shown to be associated with inflammatory response and immunosuppression. Patients receiving blood transfusion may have an increased risk for developing postoperative morbidities. The impact of blood transfusion on the postoperative recurrence of Crohn's disease (CD) has been controversial. The aim of this study was to assess the effect of blood transfusion on postoperative outcomes in CD in the current biological era.


METHODS
This historical cohort study involved data collection and analysis of CD patients who underwent the index ileocolonic resection in our institution between 2000 and 2012. Postoperative complications were compared between the transfused and nontransfused patients. The effects of perioperative blood transfusion on postoperative complications and disease recurrence were analyzed with both univariate and multivariate analyses.


RESULTS
A total of 318 patients were included in the study, and 52 of them (16.5 %) received perioperative blood transfusion. Blood transfusion was found to be associated with an increased risk of postoperative infectious and noninfectious complications both in univariate (P < 0.001 for each) and multivariable analyses (infectious complications: odds ratio [OR] = 8.73, 95 % confidence interval [CI] 2.85-26.78, P < 0.001; noninfectious complications: OR = 3.64, 95 % CI 1.30-10.18; P = 0.014). In addition, the Cox regression model indicated that blood transfusion was associated with both surgical (hazard ratio [HR] = 3.43, 95 % CI 1.92-6.13; P < 0.001) and endoscopic (HR = 2.08, 95 % CI 1.38-3.14; P < 0.001) CD recurrence following the index surgery.


CONCLUSIONS
Adverse outcomes after perioperative blood transfusion for the primary ileocolonic resection for CD resemble findings in surgery for other diseases. The presumed immunosuppressive effect of blood transfusion did not confer any protective effect on disease recurrence.
Department of Colorectal Surgery, the Cleveland Clinic Foundation, Cleveland, OH, USA.
Yi
Y
Li
Department of Colorectal Surgery, the Cleveland Clinic Foundation, Cleveland, OH, USA.
Luca
L
Stocchi
Department of Colorectal Surgery, the Cleveland Clinic Foundation, Cleveland, OH, USA.
Yuanyi
Y
Rui
Department of Colorectal Surgery, the Cleveland Clinic Foundation, Cleveland, OH, USA.
Ganglei
G
Liu
Department of Colorectal Surgery, the Cleveland Clinic Foundation, Cleveland, OH, USA.
Emre
E
Gorgun
Department of Colorectal Surgery, the Cleveland Clinic Foundation, Cleveland, OH, USA.
Feza H
FH
Remzi
Department of Gastroenterology/Hepatology, the Cleveland Clinic Foundation, Cleveland, OH, USA. shenb@ccf.org.|Center for Inflammatory Bowel Disease, Digestive Disease Institute, Desk A31, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. shenb@ccf.org.
Bo
B
Shen
D000328:Adult; D015331:Cohort Studies; D003082:Colectomy / Q000009:adverse effects*; D003424:Crohn Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D007239:Infections / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000009:adverse effects; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D065227:Transfusion Reaction; D055815:Young Adult
Blood transfusion; Bowel resection; Complications; Crohn’s disease; Recurrence