title: Blood transfusion is an independent predictor of morbidity and mortality after hepatectomy.
abstract: Previous studies have indicated that blood transfusion is associated with increased risk of worse outcomes among patients selected for hepatectomy. However, the independent effect of transfusion has not been confirmed. We hypothesize that blood transfusion is an independent factor that affects outcomes in patients undergoing hepatectomy.
  
  
  
  Patients at tertiary care center who underwent hepatectomy between 2006 and 2013 were identified and linked with the American College of Surgeons National Surgical Quality Improvement Program PUF data set. Multivariable logistic regression analysis was used to estimate the effect of blood transfusion on 30-d mortality and morbidity, adjusted for differences in extent of resection and estimated probabilities of morbidity and mortality.
  
  
  
  Among 522 patients in the study, 48 (9.2%) patients required perioperative blood transfusion within 72 h of resection, and 172 (33%) underwent major hepatectomy. Indications for hepatectomy included metastatic neoplasm (n = 229, 44%), primary hepatic neoplasm (n = 108, 21%), primary extra-hepatic biliary neoplasm (n = 23, 4%), and nonmalignant indications (n = 162, 31%). Eighty-eight (17%) patients had a postoperative morbidity. Blood transfusion was significantly associated with postoperative morbidity (odds ratio [OR] = 4.18, 95% CI = 2.18-8.02, P = 0.0001) and mortality (OR = 14.5, 95% CI = 3.08-67.8, P = 001), after adjustment for the concurrent effect of National Surgical Quality Improvement Program estimated probability of morbidity (OR = 1.15, 95% CI = 0.11-12.2, P = 0.042). The extent of resection was not significantly associated with morbidity (OR = 1.30, 95% CI, 0.74-2.28, P = 0.366) or mortality (OR = 1.14, 95% CI = 0.24-5.50, P = 0.870).
  
  
  
  Blood transfusion is a highly statistically significant independent predictor of morbidity and mortality after hepatectomy. Judicious use of perioperative transfusion is indicated in patients with benign and malignant indications for liver resection.
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Allison N
authors.initials: AN
authors.lastname: Martin
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Kerwin
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, Virginia; Surgical Outcomes Research Center, University of Virginia, Charlottesville, Virginia.
authors.forename: Florence E
authors.initials: FE
authors.lastname: Turrentine
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Todd W
authors.initials: TW
authors.lastname: Bauer
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Reid B
authors.initials: RB
authors.lastname: Adams
authors.affiliation: Surgical Outcomes Research Center, University of Virginia, Charlottesville, Virginia; Division of Patient Outcomes, Policy & Population Research, University of Virginia, Charlottesville, Virginia.
authors.forename: George J
authors.initials: GJ
authors.lastname: Stukenborg
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, Virginia; Surgical Outcomes Research Center, University of Virginia, Charlottesville, Virginia. Electronic address: vz8h@virginia.edu.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Zaydfudim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D065227:Transfusion Reaction; D055815:Young Adult
keywords: Blood transfusion; Hepatectomy; Liver resection; Perioperative morbidity; Perioperative mortality