Blood transfusions in colorectal cancer surgery

Incidence, outcomes, and predictive factors: An American College of Surgeons National Surgical Quality Improvement Program analysis

Wissam J Halabi, Mehraneh D. Jafari, Vinh Q. Nguyen, Joseph C. Carmichael, Steven Mills, Alessio Pigazzi, Michael J. Stamos

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Background Data analyzing the short-term outcomes and predictors of blood transfusions (BTs) in colorectal cancer (CRC) surgery are limited. Methods The American College of Surgeons National Surgical Quality Improvement Program (2005 to 2010) was retrospectively reviewed for CRC cases performed with or without BT. Patient demographics, comorbidities, and operative variables were analyzed. Multivariate regression analysis was performed examining the effect of BT on outcomes. The LASSO algorithm for logistic regression was used to build a predictive model for BT taking into account preoperative and operative variables. Results A total of 27,120 patients underwent CRC, and 3,815 (14.07%) had BTs. Transfusions were associated with increased mortality (odds ratio [OR], 1.78), morbidity (OR, 2.38), length of stay (mean difference, 3.52 days), pneumonia (OR, 2.70), and surgical-site infection (OR, 1.45). This effect was "dose dependent," as patients receiving ≥3 U of blood had increased morbidity (OR, 1.53), lengths of stay (mean difference, 1.82 days), pneumonia (OR, 2.52), and surgical-site infections (OR, 1.60) compared with those receiving 1 to 2 U. Predictors of BT were hematocrit <38%, open surgery, proctectomy, low platelet count, American Society of Anesthesiologists class IV or V, total colectomy, metastatic cancer, emergency, ascites, and infection. All P values were <.05. Conclusions BTs are associated with worse short-term outcomes after CRC surgery. Knowledge of predictive factors will help in risk stratification and counseling.

Original languageEnglish (US)
Pages (from-to)1024-1033
Number of pages10
JournalAmerican Journal of Surgery
Volume206
Issue number6
DOIs
StatePublished - Dec 1 2013
Externally publishedYes

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Colorectal Surgery
Quality Improvement
Blood Transfusion
Colorectal Neoplasms
Odds Ratio
Incidence
Surgical Wound Infection
Length of Stay
Pneumonia
Morbidity
Colectomy
Platelet Count
Hematocrit
Ascites
Comorbidity
Counseling
Emergencies
Multivariate Analysis
Logistic Models
Regression Analysis

Keywords

  • Blood transfusions
  • Colorectal cancer
  • NSQIP
  • Outcomes
  • Predictive factors

ASJC Scopus subject areas

  • Surgery

Cite this

Blood transfusions in colorectal cancer surgery : Incidence, outcomes, and predictive factors: An American College of Surgeons National Surgical Quality Improvement Program analysis. / Halabi, Wissam J; Jafari, Mehraneh D.; Nguyen, Vinh Q.; Carmichael, Joseph C.; Mills, Steven; Pigazzi, Alessio; Stamos, Michael J.

In: American Journal of Surgery, Vol. 206, No. 6, 01.12.2013, p. 1024-1033.

Research output: Contribution to journalArticle

Halabi, Wissam J ; Jafari, Mehraneh D. ; Nguyen, Vinh Q. ; Carmichael, Joseph C. ; Mills, Steven ; Pigazzi, Alessio ; Stamos, Michael J. / Blood transfusions in colorectal cancer surgery : Incidence, outcomes, and predictive factors: An American College of Surgeons National Surgical Quality Improvement Program analysis. In: American Journal of Surgery. 2013 ; Vol. 206, No. 6. pp. 1024-1033.
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abstract = "Background Data analyzing the short-term outcomes and predictors of blood transfusions (BTs) in colorectal cancer (CRC) surgery are limited. Methods The American College of Surgeons National Surgical Quality Improvement Program (2005 to 2010) was retrospectively reviewed for CRC cases performed with or without BT. Patient demographics, comorbidities, and operative variables were analyzed. Multivariate regression analysis was performed examining the effect of BT on outcomes. The LASSO algorithm for logistic regression was used to build a predictive model for BT taking into account preoperative and operative variables. Results A total of 27,120 patients underwent CRC, and 3,815 (14.07{\%}) had BTs. Transfusions were associated with increased mortality (odds ratio [OR], 1.78), morbidity (OR, 2.38), length of stay (mean difference, 3.52 days), pneumonia (OR, 2.70), and surgical-site infection (OR, 1.45). This effect was {"}dose dependent,{"} as patients receiving ≥3 U of blood had increased morbidity (OR, 1.53), lengths of stay (mean difference, 1.82 days), pneumonia (OR, 2.52), and surgical-site infections (OR, 1.60) compared with those receiving 1 to 2 U. Predictors of BT were hematocrit <38{\%}, open surgery, proctectomy, low platelet count, American Society of Anesthesiologists class IV or V, total colectomy, metastatic cancer, emergency, ascites, and infection. All P values were <.05. Conclusions BTs are associated with worse short-term outcomes after CRC surgery. Knowledge of predictive factors will help in risk stratification and counseling.",
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AU - Mills, Steven

AU - Pigazzi, Alessio

AU - Stamos, Michael J.

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N2 - Background Data analyzing the short-term outcomes and predictors of blood transfusions (BTs) in colorectal cancer (CRC) surgery are limited. Methods The American College of Surgeons National Surgical Quality Improvement Program (2005 to 2010) was retrospectively reviewed for CRC cases performed with or without BT. Patient demographics, comorbidities, and operative variables were analyzed. Multivariate regression analysis was performed examining the effect of BT on outcomes. The LASSO algorithm for logistic regression was used to build a predictive model for BT taking into account preoperative and operative variables. Results A total of 27,120 patients underwent CRC, and 3,815 (14.07%) had BTs. Transfusions were associated with increased mortality (odds ratio [OR], 1.78), morbidity (OR, 2.38), length of stay (mean difference, 3.52 days), pneumonia (OR, 2.70), and surgical-site infection (OR, 1.45). This effect was "dose dependent," as patients receiving ≥3 U of blood had increased morbidity (OR, 1.53), lengths of stay (mean difference, 1.82 days), pneumonia (OR, 2.52), and surgical-site infections (OR, 1.60) compared with those receiving 1 to 2 U. Predictors of BT were hematocrit <38%, open surgery, proctectomy, low platelet count, American Society of Anesthesiologists class IV or V, total colectomy, metastatic cancer, emergency, ascites, and infection. All P values were <.05. Conclusions BTs are associated with worse short-term outcomes after CRC surgery. Knowledge of predictive factors will help in risk stratification and counseling.

AB - Background Data analyzing the short-term outcomes and predictors of blood transfusions (BTs) in colorectal cancer (CRC) surgery are limited. Methods The American College of Surgeons National Surgical Quality Improvement Program (2005 to 2010) was retrospectively reviewed for CRC cases performed with or without BT. Patient demographics, comorbidities, and operative variables were analyzed. Multivariate regression analysis was performed examining the effect of BT on outcomes. The LASSO algorithm for logistic regression was used to build a predictive model for BT taking into account preoperative and operative variables. Results A total of 27,120 patients underwent CRC, and 3,815 (14.07%) had BTs. Transfusions were associated with increased mortality (odds ratio [OR], 1.78), morbidity (OR, 2.38), length of stay (mean difference, 3.52 days), pneumonia (OR, 2.70), and surgical-site infection (OR, 1.45). This effect was "dose dependent," as patients receiving ≥3 U of blood had increased morbidity (OR, 1.53), lengths of stay (mean difference, 1.82 days), pneumonia (OR, 2.52), and surgical-site infections (OR, 1.60) compared with those receiving 1 to 2 U. Predictors of BT were hematocrit <38%, open surgery, proctectomy, low platelet count, American Society of Anesthesiologists class IV or V, total colectomy, metastatic cancer, emergency, ascites, and infection. All P values were <.05. Conclusions BTs are associated with worse short-term outcomes after CRC surgery. Knowledge of predictive factors will help in risk stratification and counseling.

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