A Comprehensive Assessment of Transfusion in Elective Pancreatectomy: Risk Factors and Complications

• Published in: Journal of gastrointestinal surgery Vol. 17; no. 4; pp. 627 - 635
• Main Authors: Sun, Raphael C., Button, Anna M., Smith, Brian J., Leblond, Richard F., Howe, James R., Mezhir, James J.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.04.2013; Springer Nature B.V
• Subjects: 2012 SSAT Poster Presentation; Adult; Aged; Aged, 80 and over; Anesthesiology; Blood; Blood Transfusion - statistics & numerical data; Body mass index; Elective Surgical Procedures; Female; Gastroenterology; Hospital costs; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Pancreatectomy; Patients; Pneumonia; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Prospective Studies; Quality improvement; Risk factors; Surgeons; Surgery; Transfusion Reaction; Young Adult; United States > US; Iowa City Iowa; Transfusion; Complications; Pancreatic cancer; Pancreatectomy; Pancreatitis
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-013-2169-6

Background Specific data are needed regarding the impact of transfusion on operative complications in pancreatectomy. The objectives of this study were to determine risk factors for transfusion and to evaluate the potential association between transfusion and operative complications in elective pancreatectomy procedures. Study Design We reviewed our institution’s pancreatectomy and ACS-NSQIP databases. Multivariate analysis was used to determine clinicopathologic risk factors predictive of transfusion, and then a transfusion propensity score was developed to evaluate the impact of transfusion on post-pancreatectomy complications. Results Of the 173 patients who were treated from September 2007 to September 2011, 78 patients (45 %) were transfused ≥ 1 unit of blood (median, 3.0 units; range, 1–55). Risk factors for transfusion included increasing Body Mass Index (BMI), smoking, increasing mortality risk score, preoperative anemia, intraoperative blood loss, and benign pathology. After controlling for these risk factors using a transfusion propensity score, transfusion was an independent predictor of increased complications, infectious complications, and hospital costs. Conclusions Multiple factors are predictive of transfusion in pancreatectomy, including increasing BMI and smoking. When controlling for transfusion propensity based on these risk factors, RBC transfusion is associated with worse operative outcomes including infectious complications. Development of protocols and strategies to minimize unnecessary transfusion in pancreatectomy are justified.