Significant Variation in Blood Transfusion Practice Persists following Upper GI Cancer Resection.
OBJECTIVE
Perioperative blood transfusions are costly and linked to adverse clinical outcomes. We investigated the factors associated with variation in blood transfusion utilization following upper gastrointestinal cancer resection and its association with infectious complications.


METHODS
The Statewide Planning and Research Cooperative System was queried for elective esophagectomy, gastrectomy, and pancreatectomy for malignancy in NY State from 2001 to 2013. Bivariate and hierarchical logistic regression analyses were performed to assess the factors associated with receiving a perioperative allogeneic red blood cell transfusion. Additional multivariable analysis examined the relationship between transfusion and infectious complications.


RESULTS
Among 14,875 patients who underwent upper GI cancer resection, 32 % of patients received a perioperative blood transfusion. After controlling for patient, surgeon, and hospital-level factors, significant variation in transfusion rates was present across both surgeons (p < 0.0001) and hospitals (p < 0.0001). Receipt of a blood transfusion was also independently associated with wound infection (OR = 1.68, 95% CI = 1.47 and 1.91), pneumonia (OR = 1.98, 95% CI = 1.74 and 2.26), and sepsis (OR = 2.49, 95% CI = 2.11 and 2.94).


CONCLUSIONS
Significant variation in perioperative blood transfusion utilization is present at both the surgeon and hospital level. These findings are unexplained by patient-level factors and other known hospital characteristics, suggesting that variation is due to provider preferences and/or lack of standardized transfusion protocols. Implementing institutional transfusion guidelines is necessary to limit unwarranted variation and reduce infectious complication rates.
Department of Surgery, Surgical Health Outcomes & Research Enterprise (SHORE), University of Rochester Medical Center, Box SURG, 601 Elmwood Ave, Rochester, NY, 14642, USA. christopher_aquina@urmc.rochester.edu.
Christopher T
http://orcid.org/0000-0002-7589-5561
CT
Aquina
Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, 14642, USA.
Neil
N
Blumberg
Department of Surgery, Surgical Health Outcomes & Research Enterprise (SHORE), University of Rochester Medical Center, Box SURG, 601 Elmwood Ave, Rochester, NY, 14642, USA.
Christian P
CP
Probst
Department of Surgery, Surgical Health Outcomes & Research Enterprise (SHORE), University of Rochester Medical Center, Box SURG, 601 Elmwood Ave, Rochester, NY, 14642, USA.
Adan Z
AZ
Becerra
Department of Surgery, Surgical Health Outcomes & Research Enterprise (SHORE), University of Rochester Medical Center, Box SURG, 601 Elmwood Ave, Rochester, NY, 14642, USA.
Bradley J
BJ
Hensley
Department of Surgery, Surgical Health Outcomes & Research Enterprise (SHORE), University of Rochester Medical Center, Box SURG, 601 Elmwood Ave, Rochester, NY, 14642, USA.
James C
JC
Iannuzzi
Department of Surgery, Surgical Health Outcomes & Research Enterprise (SHORE), University of Rochester Medical Center, Box SURG, 601 Elmwood Ave, Rochester, NY, 14642, USA.
Maynor G
MG
Gonzalez
Department of Surgery, Surgical Health Outcomes & Research Enterprise (SHORE), University of Rochester Medical Center, Box SURG, 601 Elmwood Ave, Rochester, NY, 14642, USA.
Andrew-Paul
AP
Deeb
Department of Surgery, Surgical Health Outcomes & Research Enterprise (SHORE), University of Rochester Medical Center, Box SURG, 601 Elmwood Ave, Rochester, NY, 14642, USA.
Katia
K
Noyes
Department of Surgery, Surgical Health Outcomes & Research Enterprise (SHORE), University of Rochester Medical Center, Box SURG, 601 Elmwood Ave, Rochester, NY, 14642, USA.
John R T
JR
Monson
Department of Surgery, Surgical Health Outcomes & Research Enterprise (SHORE), University of Rochester Medical Center, Box SURG, 601 Elmwood Ave, Rochester, NY, 14642, USA.
Fergal J
FJ
Fleming
D000368:Aged; D000369:Aged, 80 and over; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D016629:Esophagectomy; D005260:Female; D005743:Gastrectomy; D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York; D010180:Pancreatectomy
Blood transfusion; Health services research; Neoplasms; Upper gastrointestinal tract