title: Perioperative blood transfusion predicts short term morbidity after nephrectomy.
abstract: BACKGROUND
  To assess 30-day morbidity and mortality following partial nephrectomy (PN) and radical nephrectomy (RN) with relation to the administration of perioperative blood transfusions PBT).
  
  
  METHODS
  The National Surgical Quality Improvement Program was queried for patients with malignant renal tumors (International Classification of Diseases Ninth Revision codes 189-189.2) who underwent RN (Current Procedure Terminology codes 50220, 50225, 50230, 50234, 50236, 50545, 50546, 50548) or PN (50240, 50543) between 2005-2013. Patients were stratified by transfusion status and assessed for postoperative outcomes both separately and in composite, including morbidity, mortality, infectious complications, and pulmonary complications. Univariate and multivariate analyses were performed to identify significant independent predictors of these composite outcomes.
  
  
  RESULTS
  The overall transfusion rates were 15.8% and 8.2% for RN and PN, respectively. On multivariate analysis, PBT was associated with increased morbidity (RN: OR 2.147, 95% CI 1.687-2.733; PN: OR 2.081, 95% CI 1.434-3.022), mortality (RN: OR 2.308, 95% CI 1.159-4.598; PN: OR 5.166, 95% CI 1.207-22.12), infectious complications (RN: OR 1.656, 95% CI 1.151-2.383; PN: OR 1.945, 95% CI 1.128-3.354) and pulmonary complications (RN: OR 3.040, 95% CI 2.125-4.349; OR 3.771, 95% CI 2.108-6.746).
  
  
  CONCLUSIONS
  For patients undergoing RN or PN there is a significant association between receipt of PBT and 30-day postoperative outcomes, specifically overall morbidity, mortality, infectious complications, and pulmonary complications. The mechanism that underlies these effects has not been elucidated, but it most likely involves immunomodulation and acute lung injury. Future research should focus on formulating comprehensive transfusion guidelines for oncologic-related nephrectomies.
authors.affiliation: Herbert Irving Cancer Center, New York-Presbyterian Hospital/Columbia University Medical Center and Columbia University College of Physicians and Surgeons, New York, New York USA.
authors.forename: Wilson
authors.initials: W
authors.lastname: Sui
authors.forename: Ifeanyi C
authors.initials: IC
authors.lastname: Onyeji
authors.forename: Justin T
authors.initials: JT
authors.lastname: Matulay
authors.forename: Marissa C
authors.initials: MC
authors.lastname: Theofanides
authors.forename: Maxwell B
authors.initials: MB
authors.lastname: James
authors.forename: G Joel
authors.initials: GJ
authors.lastname: DeCastro
authors.forename: Sven
authors.initials: S
authors.lastname: Wenske
mesh_terms: D000368:Aged; D001803:Blood Transfusion / Q000379:methods; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D058996:Quality Improvement; D012189:Retrospective Studies; D018570:Risk Assessment; D065227:Transfusion Reaction; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology