title: Longer average blood storage duration is associated with increased risk of infection and overall morbidity following radical cystectomy.
abstract: Patients with bladder cancer undergoing radical cystectomy (RC) experience high rates of perioperative blood transfusions (PBTs) and morbidity. The aim of this study was to evaluate the effect of blood storage duration on the risk of adverse perioperative outcomes in this high-risk patient population.
  
  
  
  In a retrospective review of RC patients from 2010 to 2014 who received PBTs, the average storage duration for all units transfused was used to classify patients as receiving older blood using 3 different definitions (≥21 days,≥28 days, and≥35 days). Multivariable Poisson regression models were used to determine the adjusted relative risk of perioperative infections and overall morbidity in those given older blood compared to fresher blood.
  
  
  
  Of the 451 patients undergoing RC, 205 (45%) received nonirradiated PBTs. In multivariable modeling, increasing average blood storage duration, as a continuous variable, was associated with an increased risk of infections (risk ratio [RR] = 1.08 per day, 95% CI: 1.01-1.17) and overall morbidity (RR = 1.08 per day, 95% CI: 1.01-1.15). Furthermore, ≥28-day blood storage (vs.<28) was associated with increased infections (RR = 2.69, 95% CI: 1.18-6.14) and morbidity (RR = 2.54, 95% CI: 1.31-4.95), and ≥35-day blood storage (vs.<35) was also associated with increased infections (RR = 2.83, 95% CI: 1.42-5.66) and morbidity (RR = 3.35, 95% CI: 1.95-5.77).
  
  
  
  Although blood is stored up to 42 days, storage≥28 days may expose RC patients to increased perioperative infections and overall morbidity compared with storage<28 days. Prospective cohort studies are warranted in cystectomy and other high-risk surgical oncology patients to better determine the effect of blood storage duration.
authors: The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: mchappi1@jhmi.edu.
authors: Meera R
authors: MR
authors: Chappidi
authors: The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Heather J
authors: HJ
authors: Chalfin
authors: Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Daniel J
authors: DJ
authors: Johnson
authors: The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Max
authors: M
authors: Kates
authors: The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Nikolai A
authors: NA
authors: Sopko
authors: The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Michael H
authors: MH
authors: Johnson
authors: Department of Urology, Oregon Health & Science University, Portland, OR.
authors: Jen-Jane
authors: JJ
authors: Liu
authors: Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Steven M
authors: SM
authors: Frank
authors: The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Trinity J
authors: TJ
authors: Bivalacqua
mesh_terms: D000368:Aged; D001793:Blood Preservation / Q000009:adverse effects / Q000379:methods*; D001803:Blood Transfusion / Q000379:methods; D015897:Comorbidity; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007239:Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology / Q000601:surgery*
keywords: Bladder cancer; Blood transfusion; Cystectomy; Infection; Postoperative complications