title: Peri-operative allogeneic blood transfusion and outcomes after radical cystectomy: a population-based study.
abstract: BACKGROUND
  To describe factors associated with peri-operative blood transfusion (PBT) at radical cystectomy (RC) for patients with bladder cancer and evaluate its association on both early and late outcomes.
  
  
  METHODS
  Electronic records of treatment and surgical pathology reports were linked to the population-based Ontario Cancer Registry to identify all patients who underwent RC between 2000 and 2008. Modified Poisson regression model was used to determine the factors associated with PBT. A Cox-proportional hazards regression model was used to explore the association between PBT and overall (OS) and cancer-specific (CSS) survival.
  
  
  RESULTS
  Among 2593 patients identified, 62% received an allogeneic red blood cell transfusion. The frequency of PBT decreased over the study period (from 68 to 54%, p < 0.001). Factors associated with PBT included age, sex, greater co-morbidity, stage, and surgeon volume. PBT was associated with inferior outcomes, including median length of stay (11 vs. 9 days, p < 0.001), 90-day re-admission rate (38 vs. 29%, p < 0.001), and mortality (11 vs. 4%, p < 0.001). OS and CSS at 5 years were lower among patients with PBT on multivariate analysis (OS HR 1.33, 95% CI 1.20-1.48; CSS HR 1.39, 95% CI 1.23-1.56).
  
  
  CONCLUSIONS
  Although rates are decreasing, these data suggest a very high utilization rate of PBT at time of RC in routine clinical practice. PBT is associated with substantially worse early outcomes and long-term survival. This association persists despite adjustment for disease-, patient-, and provider-related factors, suggesting that PBT is an important indicator of surgical care of RC.
authors.affiliation: Department of Urology, Kingston General Hospital, Queen's University, Victory 4, 76 Stuart St., Kingston, ON, K7L 2V7, Canada. siemensr@kgh.kari.net.|Department of Oncology, Queen's University, Kingston, Canada. siemensr@kgh.kari.net.
authors.forename: D Robert
authors.initials: DR
authors.lastname: Siemens
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Canada.
authors.forename: Melanie T
authors.initials: MT
authors.lastname: Jaeger
authors.affiliation: Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada.
authors.forename: Xuejiao
authors.initials: X
authors.lastname: Wei
authors.affiliation: Department of Oncology, Queen's University, Kingston, Canada.
authors.forename: Francisco
authors.initials: F
authors.lastname: Vera-Badillo
authors.affiliation: Department of Oncology, Queen's University, Kingston, Canada.|Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Booth
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000628:therapy*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery*; D002423:Cause of Death; D015331:Cohort Studies; D015897:Comorbidity; D015653:Cystectomy; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010359:Patient Readmission; D019990:Perioperative Care; D010949:Plasma; D017713:Platelet Transfusion; D016012:Poisson Distribution; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D015996:Survival Rate; D014184:Transplantation, Homologous; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D055815:Young Adult
keywords: Bladder cancer; Health services; Outcomes; Quality of care; Survival; Transfusion