title: Predictive factors for perioperative blood transfusions in partial nephrectomy for renal masses.
abstract: BACKGROUND
  Allogeneic perioperative blood transfusions (PBT) have been associated with higher rates of postoperative complications and tumour recurrence in a number of malignancies. This study evaluates the risk factors for PBT in patients undergoing partial nephrectomy (PN), in order to identify patients who could benefit from alternatives to allogenic blood.
  
  
  METHODS
  Data on 822 patients who underwent elective PN between 1988 and 2013 were analysed. Patient demographics and clinicopathologic variables were collected retrospectively. PBT was defined as transfusion of allogeneic red blood cells during PN (in the operating-room) or postoperative hospitalization.
  
  
  RESULTS
  Of the 822 patients, 122 (14.8%) received PBT. Of these, 45.9% were transfused intraoperatively and 47.5% in the postoperative period. Only 14.3% of the patients who were transfused intraoperatively required additional postoperative transfusions. On multivariable analysis, age ≥65 (P < 0.01), lower preoperative haemoglobin levels (P < 0.001), larger renal masses (P < 0.001), central lesions (P < 0.01) and cumulative surgical experience (P < 0.001) were found to be associated with higher rate of PBT.
  
  
  CONCLUSIONS
  Age, low preoperative haemoglobin level, lesion size, surgeons' experience and central renal lesions are independent pre-operative risk factors for PBT in patients undergoing PN. Evaluation of these risk factors prior to surgery may be helpful in constituting guidelines for a more responsible use of allogeneic blood and its alternatives.
authors.affiliation: Department of Urology, Chaim Sheba Medical Centre, Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Abu-Ghanem
authors.affiliation: Department of Urology, Chaim Sheba Medical Centre, Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Zohar
authors.initials: Z
authors.lastname: Dotan
authors.affiliation: Department of Urology, Chaim Sheba Medical Centre, Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Issac
authors.initials: I
authors.lastname: Kaver
authors.affiliation: Department of Urology, Chaim Sheba Medical Centre, Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Jacob
authors.initials: J
authors.lastname: Ramon
mesh_terms: D000368:Aged; D001803:Blood Transfusion; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy; D019990:Perioperative Care; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment
chemical_list: D006454:Hemoglobins
keywords: allogeneic; partial nephrectomy; perioperative blood transfusions; predictive factors