title: Blood Transfusion Requirement and Not Preoperative Anemia Are Associated with Perioperative Complications Following Intracorporeal Robot-Assisted Radical Cystectomy.
abstract: To assess the prevalence of preoperative anemia and the impact of preoperative anemia and blood transfusion requirement on 30- and 90-day complications in a cohort of patients undergoing robot-assisted radical cystectomy with intracorporeal urinary diversion (iRARC).
  
  
  
  IRARC was performed on 166 patients between June 2011 and March 2016. Prospective data were collected for patient demographics, clinical and pathologic characteristics, perioperative variables, transfusion requirements, and hospital length of stay. Thirty- and 90-day complications were classified according to the modified Memorial Sloan Kettering Cancer Center Clavien-Dindo system.
  
  
  
  Preoperative anemia was common (43.4%) and greatest in patients receiving neoadjuvant chemotherapy (48.6%) (p < 0.001). Patients with preoperative anemia were significantly more likely to have an Ileal conduit (p = 0.033), higher cystectomy stage (≥pT3) (p = 0.028), and a lower lymph node yield (p = 0.031). Preoperative anemia was not associated with increased perioperative morbidity but was associated with the requirement for blood transfusion (p = 0.001). Blood transfusion required in 20.4% of patients with intraoperative and postoperative blood transfusion rate was 10.2% and 13.9%, respectively. The 30-day all complication rate and 30-day major complication rate were 55.4% and 15.7%, respectively, while 90-day all complication rate and 90-day major complication rate were 65.7% and 19.3%, respectively. Intraoperative blood transfusion was not associated with increased complications, but postoperative blood transfusion requirement was independently associated with perioperative morbidity: all 30-day complications (p = 0.003), all 90-day complications (p = 0.009), and 90-day major complications (p = 0.004).
  
  
  
  The presence of preoperative anemia in patients undergoing iRARC is not associated with increased surgical risk, although preoperative anemic patients were significantly more likely to require blood transfusion. Blood transfusion requirement and specifically postoperative blood transfusion are independently associated with perioperative morbidity and are an important factor for the optimization of postoperative outcomes.
authors.affiliation: 1 Division of Surgery and Interventional Science, University College London , London, United Kingdom .|2 Department of Urology, University College London Hospital , London, United Kingdom .
authors.forename: Wei Shen
authors.initials: WS
authors.lastname: Tan
authors.affiliation: 2 Department of Urology, University College London Hospital , London, United Kingdom .
authors.forename: Benjamin W
authors.initials: BW
authors.lastname: Lamb
authors.affiliation: 1 Division of Surgery and Interventional Science, University College London , London, United Kingdom .|2 Department of Urology, University College London Hospital , London, United Kingdom .
authors.forename: Pramit
authors.initials: P
authors.lastname: Khetrapal
authors.affiliation: 3 School of Medicine, University of Glasgow , Glasgow, Scotland, United Kingdom .
authors.forename: Mae-Yen
authors.initials: MY
authors.lastname: Tan
authors.affiliation: 4 Department of Anaesthesia and Perioperative Medicine, University College London Hospital , London, United Kingdom .
authors.forename: Melanie El
authors.initials: ME
authors.lastname: Tan
authors.affiliation: 1 Division of Surgery and Interventional Science, University College London , London, United Kingdom .|2 Department of Urology, University College London Hospital , London, United Kingdom .
authors.forename: Ashwin
authors.initials: A
authors.lastname: Sridhar
authors.affiliation: 4 Department of Anaesthesia and Perioperative Medicine, University College London Hospital , London, United Kingdom .
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Cervi
authors.affiliation: 1 Division of Surgery and Interventional Science, University College London , London, United Kingdom .|2 Department of Urology, University College London Hospital , London, United Kingdom .
authors.forename: Simon
authors.initials: S
authors.lastname: Rodney
authors.affiliation: 2 Department of Urology, University College London Hospital , London, United Kingdom .
authors.forename: Gerald
authors.initials: G
authors.lastname: Busuttil
authors.affiliation: 1 Division of Surgery and Interventional Science, University College London , London, United Kingdom .|2 Department of Urology, University College London Hospital , London, United Kingdom .
authors.forename: Senthil
authors.initials: S
authors.lastname: Nathan
authors.affiliation: 2 Department of Urology, University College London Hospital , London, United Kingdom .
authors.forename: John
authors.initials: J
authors.lastname: Hines
authors.affiliation: 2 Department of Urology, University College London Hospital , London, United Kingdom .
authors.forename: Greg
authors.initials: G
authors.lastname: Shaw
authors.affiliation: 2 Department of Urology, University College London Hospital , London, United Kingdom .
authors.forename: Anna
authors.initials: A
authors.lastname: Mohammed
authors.affiliation: 2 Department of Urology, University College London Hospital , London, United Kingdom .
authors.forename: Hilary
authors.initials: H
authors.lastname: Baker
authors.affiliation: 2 Department of Urology, University College London Hospital , London, United Kingdom .
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Briggs
authors.affiliation: 5 Department of Anaesthesia and Intensive Care, Papworth Hospital , Papworth, United Kingdom .
authors.forename: Andrew
authors.initials: A
authors.lastname: Klein
authors.affiliation: 1 Division of Surgery and Interventional Science, University College London , London, United Kingdom .
authors.forename: Toby
authors.initials: T
authors.lastname: Richards
authors.affiliation: 1 Division of Surgery and Interventional Science, University College London , London, United Kingdom .|2 Department of Urology, University College London Hospital , London, United Kingdom .
authors.forename: John D
authors.initials: JD
authors.lastname: Kelly
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000453:epidemiology*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D015653:Cystectomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D059035:Perioperative Period / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000209:etiology; D057234:Preoperative Period; D015995:Prevalence; D011446:Prospective Studies; D065287:Robotic Surgical Procedures; D065227:Transfusion Reaction; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects
keywords: anemia; bladder cancer; blood transfusion; complications; cystectomy; robotics