title: Impact of a restrictive vs liberal transfusion strategy on anastomotic leakage and infectious complications after restorative surgery for rectal cancer.
abstract: OBJECTIVE
  The aim of this study was to investigate the impact of a restrictive vs liberal transfusion strategy on anastomotic leakage and infectious complications after rectal cancer surgery.
  
  
  METHODS
  Patients undergoing restorative proctectomy for rectal cancer between January 2008 and December 2013 were divided into four groups according to the perioperative lowest haemoglobin (Hgb) level and transfusion status: group 1 with Hgb level ≥ 10 g/dl; group 2 with Hgb level ≥ 7 and < 10 g/dl who did not receive transfusion; and group 3 with Hgb level ≥ 7 and < 10 g/dl and group 4 with Hgb level < 7 g/dl, both of which received a transfusion. Clinical characteristics, anastomotic leakage and infectious complications within 30 days of surgery were compared.
  
  
  RESULTS
  There were 398 patients (66% men) with a mean age of 59.3 ± 11.9 years. Groups 1, 2, 3 and 4 included 162 (40.7%), 163 (41.0%), 47 (11.8%) and 26 (6.5%) patients, respectively. Perioperative characteristics were significantly different among groups regarding neoadjuvant chemo/radiotherapy use, preoperative albumin and Hgb levels, operative approach and blood loss, tumour size and stage, surgical margin involvement and histological differentiation. The unadjusted rates of overall infectious complications were 17.2%, 27.6%, 36.2% and 50% in groups 1, 2, 3 and 4, respectively (P = 0.001). In the multivariate analysis, compared to group 2, group 3 was associated with an increased likelihood of organ/space surgical site infections (SSIs) (OR 3.63, 95% CI 1.29-10.22, P = 0.01) with no significant differences in terms of anastomotic leakage, overall SSIs or overall infectious complications.
  
  
  CONCLUSIONS
  Blood transfusion of haemodynamically stable patients with Hgb level ≥ 7 g/dl is associated with increased organ/space SSIs in rectal cancer surgery.
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: V
authors.initials: V
authors.lastname: Ozben
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: L
authors.initials: L
authors.lastname: Stocchi
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: J
authors.initials: J
authors.lastname: Ashburn
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: X
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: E
authors.initials: E
authors.lastname: Gorgun
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology / Q000628:therapy*; D001803:Blood Transfusion / Q000379:methods*; D016208:Databases, Factual; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D057234:Preoperative Period; D016737:Proctocolectomy, Restorative / Q000009:adverse effects; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D013530:Surgical Wound Infection / Q000209:etiology / Q000628:therapy*; D065227:Transfusion Reaction / Q000209:etiology*; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D006454:Hemoglobins; D012709:Serum Albumin
keywords: Transfusion threshold; anastomotic leakage; infectious complications; rectal cancer surgery