Transfusion requirements in surgical oncology patients: a prospective, randomized controlled trial

Several studies have indicated that a restrictive erythrocyte transfusion strategy is as safe as a liberal one in critically ill patients, but there is no clear evidence to support the superiority of any perioperative transfusion strategy in patients with cancer. In a randomized, controlled, paralle...

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Published inAnesthesiology (Philadelphia) Vol. 122; no. 1; pp. 29 - 38
Main Authors de Almeida, Juliano Pinheiro, Vincent, Jean-Louis, Galas, Filomena Regina Barbosa Gomes, de Almeida, Elisangela Pinto Marinho, Fukushima, Julia T, Osawa, Eduardo A, Bergamin, Fabricio, Park, Clarice Lee, Nakamura, Rosana Ely, Fonseca, Silvia M R, Cutait, Guilherme, Alves, Joseane Inacio, Bazan, Mellik, Vieira, Silvia, Sandrini, Ana C Vieira, Palomba, Henrique, Ribeiro, Jr, Ulysses, Crippa, Alexandre, Dalloglio, Marcos, Diz, Maria del Pilar Estevez, Kalil Filho, Roberto, Auler, Jr, Jose Otavio Costa, Rhodes, Andrew, Hajjar, Ludhmila Abrahao
Format Journal Article
LanguageEnglish
Published United States 01.01.2015
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Abstract Several studies have indicated that a restrictive erythrocyte transfusion strategy is as safe as a liberal one in critically ill patients, but there is no clear evidence to support the superiority of any perioperative transfusion strategy in patients with cancer. In a randomized, controlled, parallel-group, double-blind (patients and outcome assessors) superiority trial in the intensive care unit of a tertiary oncology hospital, the authors evaluated whether a restrictive strategy of erythrocyte transfusion (transfusion when hemoglobin concentration <7 g/dl) was superior to a liberal one (transfusion when hemoglobin concentration <9 g/dl) for reducing mortality and severe clinical complications among patients having major cancer surgery. All adult patients with cancer having major abdominal surgery who required postoperative intensive care were included and randomly allocated to treatment with the liberal or the restrictive erythrocyte transfusion strategy. The primary outcome was a composite endpoint of mortality and morbidity. A total of 198 patients were included as follows: 101 in the restrictive group and 97 in the liberal group. The primary composite endpoint occurred in 19.6% (95% CI, 12.9 to 28.6%) of patients in the liberal-strategy group and in 35.6% (27.0 to 45.4%) of patients in the restrictive-strategy group (P = 0.012). Compared with the restrictive strategy, the liberal transfusion strategy was associated with an absolute risk reduction for the composite outcome of 16% (3.8 to 28.2%) and a number needed to treat of 6.2 (3.5 to 26.5). A liberal erythrocyte transfusion strategy with a hemoglobin trigger of 9 g/dl was associated with fewer major postoperative complications in patients having major cancer surgery compared with a restrictive strategy.
AbstractList BACKGROUNDSeveral studies have indicated that a restrictive erythrocyte transfusion strategy is as safe as a liberal one in critically ill patients, but there is no clear evidence to support the superiority of any perioperative transfusion strategy in patients with cancer.METHODSIn a randomized, controlled, parallel-group, double-blind (patients and outcome assessors) superiority trial in the intensive care unit of a tertiary oncology hospital, the authors evaluated whether a restrictive strategy of erythrocyte transfusion (transfusion when hemoglobin concentration <7 g/dl) was superior to a liberal one (transfusion when hemoglobin concentration <9 g/dl) for reducing mortality and severe clinical complications among patients having major cancer surgery. All adult patients with cancer having major abdominal surgery who required postoperative intensive care were included and randomly allocated to treatment with the liberal or the restrictive erythrocyte transfusion strategy. The primary outcome was a composite endpoint of mortality and morbidity.RESULTSA total of 198 patients were included as follows: 101 in the restrictive group and 97 in the liberal group. The primary composite endpoint occurred in 19.6% (95% CI, 12.9 to 28.6%) of patients in the liberal-strategy group and in 35.6% (27.0 to 45.4%) of patients in the restrictive-strategy group (P = 0.012). Compared with the restrictive strategy, the liberal transfusion strategy was associated with an absolute risk reduction for the composite outcome of 16% (3.8 to 28.2%) and a number needed to treat of 6.2 (3.5 to 26.5).CONCLUSIONA liberal erythrocyte transfusion strategy with a hemoglobin trigger of 9 g/dl was associated with fewer major postoperative complications in patients having major cancer surgery compared with a restrictive strategy.
Several studies have indicated that a restrictive erythrocyte transfusion strategy is as safe as a liberal one in critically ill patients, but there is no clear evidence to support the superiority of any perioperative transfusion strategy in patients with cancer. In a randomized, controlled, parallel-group, double-blind (patients and outcome assessors) superiority trial in the intensive care unit of a tertiary oncology hospital, the authors evaluated whether a restrictive strategy of erythrocyte transfusion (transfusion when hemoglobin concentration <7 g/dl) was superior to a liberal one (transfusion when hemoglobin concentration <9 g/dl) for reducing mortality and severe clinical complications among patients having major cancer surgery. All adult patients with cancer having major abdominal surgery who required postoperative intensive care were included and randomly allocated to treatment with the liberal or the restrictive erythrocyte transfusion strategy. The primary outcome was a composite endpoint of mortality and morbidity. A total of 198 patients were included as follows: 101 in the restrictive group and 97 in the liberal group. The primary composite endpoint occurred in 19.6% (95% CI, 12.9 to 28.6%) of patients in the liberal-strategy group and in 35.6% (27.0 to 45.4%) of patients in the restrictive-strategy group (P = 0.012). Compared with the restrictive strategy, the liberal transfusion strategy was associated with an absolute risk reduction for the composite outcome of 16% (3.8 to 28.2%) and a number needed to treat of 6.2 (3.5 to 26.5). A liberal erythrocyte transfusion strategy with a hemoglobin trigger of 9 g/dl was associated with fewer major postoperative complications in patients having major cancer surgery compared with a restrictive strategy.
Author de Almeida, Juliano Pinheiro
Alves, Joseane Inacio
Bazan, Mellik
Crippa, Alexandre
Hajjar, Ludhmila Abrahao
Rhodes, Andrew
Galas, Filomena Regina Barbosa Gomes
Bergamin, Fabricio
Fonseca, Silvia M R
de Almeida, Elisangela Pinto Marinho
Palomba, Henrique
Diz, Maria del Pilar Estevez
Cutait, Guilherme
Ribeiro, Jr, Ulysses
Auler, Jr, Jose Otavio Costa
Vieira, Silvia
Kalil Filho, Roberto
Vincent, Jean-Louis
Nakamura, Rosana Ely
Osawa, Eduardo A
Fukushima, Julia T
Dalloglio, Marcos
Park, Clarice Lee
Sandrini, Ana C Vieira
Author_xml – sequence: 1
  givenname: Juliano Pinheiro
  surname: de Almeida
  fullname: de Almeida, Juliano Pinheiro
  organization: From the Surgical Intensive Care Unit and Department of Anesthesiology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (J.P.d.A., F.R.B.G.G., E.P.M.d.A., J.T.F., E.A.O., F.B., C.L.P., R.E.N., S.M.R.F., J.I.A., M.B., S.V., A.C.V.S., H.P., R.K.F., J.O.C.A., L.A.H.); Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium (J.-L.V.); Department of Intensive Care Medicine, St. George's Healthcare NHS Trust, London, United Kingdom (A.R.); Department of Surgery, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (G.C., U.R., A.C., M.D.); and Department of Oncology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (M.d.P.E.D.)
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References 25405396 - Anesthesiology. 2015 Jan;122(1):3-4
26372130 - Anesthesiology. 2015 Oct;123(4):970-1
26372129 - Anesthesiology. 2015 Oct;123(4):968-9
26372127 - Anesthesiology. 2015 Oct;123(4):966-7
26372128 - Anesthesiology. 2015 Oct;123(4):967-8
26372131 - Anesthesiology. 2015 Oct;123(4):971-3
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Snippet Several studies have indicated that a restrictive erythrocyte transfusion strategy is as safe as a liberal one in critically ill patients, but there is no...
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SubjectTerms Abdominal Neoplasms - surgery
Brazil - epidemiology
Double-Blind Method
Erythrocyte Transfusion - methods
Erythrocyte Transfusion - statistics & numerical data
Female
Follow-Up Studies
Hemoglobins - analysis
Humans
Intensive Care Units
Male
Middle Aged
Outcome Assessment (Health Care) - statistics & numerical data
Postoperative Complications - epidemiology
Prospective Studies
Risk
Title Transfusion requirements in surgical oncology patients: a prospective, randomized controlled trial
URI https://www.ncbi.nlm.nih.gov/pubmed/25401417
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Volume 122
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