title: Long-term outcomes of an integrated transfusion reduction initiative in patients undergoing resection for colorectal cancer.
abstract: BACKGROUND
  Perioperative blood transfusion in patients with colorectal cancer has been associated with increased cost, morbidity, mortality, and decreased survival. Five years ago, a transfusion reduction initiative (TRI) was implemented. We sought to evaluate the 5-year effectiveness and patient outcomes before and after the TRI.
  
  
  METHODS
  Patients who underwent colorectal resection for adenocarcinomas before (January 2006 to October 2009) and after the TRI (November 2009 to December 2013) were reviewed.
  
  
  RESULTS
  A total of 484 patients were included; 267 and 217 patients were in the pre- and post-TRI groups, respectively. Decreased overall transfusion rates were sustained throughout the entire post-TRI era (17% vs 28%, P = .006). Three-year colorectal cancer disease-free survival rates were similar in the pre- and post-TRI eras at 85.3% (95% confidence interval [CI]: 79.9 to 89.3) and 81.6% (95% CI: 71.9 to 88.2), respectively. Three-year disease-free survival rate was lower in those receiving BTs vs those without BTs at 78.4% (95% CI: 65.7 to 86.8) vs 85.3% (95% CI: 80.4 to 89.1), respectively.
  
  
  CONCLUSIONS
  A TRI remains a safe, effective way to reduce blood utilization in colorectal cancer surgery.
authors.affiliation: Department of Medical Education, Gundersen Medical Foundation, La Crosse, WI, USA.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Van Osdol
authors.affiliation: Department of Medical Research, Gundersen Medical Foundation, La Crosse, WI, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Borgert
authors.affiliation: Department of Medical Research, Gundersen Medical Foundation, La Crosse, WI, USA.
authors.forename: Kara J
authors.initials: KJ
authors.lastname: Kallies
authors.affiliation: Department of Medical Education, Gundersen Medical Foundation, La Crosse, WI, USA.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Froman
authors.affiliation: Department of Hematology, Gundersen Health System, La Crosse, WI, USA.
authors.forename: Wayne A
authors.initials: WA
authors.lastname: Bottner
authors.affiliation: Department of General and Vascular Surgery, Gundersen Health System, 1900 South Avenue C05-001, La Crosse, WI 54601, USA. Electronic address: sbshapir@gundersenhealth.org.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Shapiro
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Blood transfusion; Cancer recurrence; Colorectal cancer; Perioperative morbidity and mortality; Survival