title: The impact of peri-operative blood transfusions on post-pancreatectomy short-term outcomes: an analysis from the American College of Surgeons National Surgical Quality Improvement Program.
abstract: BACKGROUND
  Peri-operative red blood cell transfusions (RBCT) may induce transfusion-related immunomodulation and impact post-operative recovery. This study examined the association between RBCT and post-pancreatectomy morbidity.
  
  
  METHODS
  Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) registry, patients undergoing an elective pancreatectomy (2007-2012) were identified. Patients with missing data on key variables were excluded. Primary outcomes were 30-day post-operative major morbidity, mortality, and length of stay (LOS). Unadjusted and adjusted relative risks (RR) with a 95% confidence interval (95%CI) were computed using modified Poisson, logistic, or negative binomial regression, to estimate the association between RBCT and outcomes.
  
  
  RESULTS
  The database included 21 132 patients who had a pancreatectomy during the study period. Seventeen thousand five hundred and twenty-three patients were included, and 4672 (26.7%) received RBCT. After adjustment for baseline and clinical characteristics, including comorbidities, malignant diagnosis, procedure and operative time, RBCT was independently associated with increased major morbidity (RR 1.49; 95% CI: 1.39-1.60), mortality (RR 2.19; 95%CI: 1.76-2.73) and LOS (RR 1.27; 95%CI 1.24-1.29).
  
  
  CONCLUSIONS
  Peri-operative RBCT for a pancreatectomy was independently associated with worse short-term outcomes and prolonged LOS. Future studies should focus on the impact of interventions to minimize the use of RBCT after an elective pancreatectomy.
authors: Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, ON, Canada.|Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors: Julie
authors: J
authors: Hallet
authors: Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.
authors: Alyson L
authors: AL
authors: Mahar
authors: Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors: Melanie E
authors: ME
authors: Tsang
authors: Division of Clinical Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.|Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
authors: Yulia
authors: Y
authors: Lin
authors: Division of Clinical Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.|Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
authors: Jeannie
authors: J
authors: Callum
authors: Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, ON, Canada.|Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors: Natalie G
authors: NG
authors: Coburn
authors: Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, ON, Canada.|Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors: Calvin H L
authors: CH
authors: Law
authors: Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, ON, Canada.|Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors: Paul J
authors: PJ
authors: Karanicolas
mesh_terms: D001803:Blood Transfusion / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000639:trends; D009017:Morbidity / Q000639:trends; D010180:Pancreatectomy / Q000592:standards*; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011379:Prognosis; D011446:Prospective Studies; D058996:Quality Improvement; D012042:Registries; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012955:Societies, Medical; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology