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Hepatobiliary Surg Nutr. 2018 Feb;7(1):1-10. doi: 10.21037/hbsn.2017.05.07.

The impact of perioperative blood transfusions on short-term outcomes following hepatectomy.

Author information

1
Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
2
Department of Surgery, University of Toronto, Toronto, ON, Canada.
3
Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.
4
Division of Clinical Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
5
Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.

Abstract

Background:

Bleeding and need for red blood cell transfusions (RBCT) remain a significant concern with hepatectomy. RBCT carry risk of transfusion-related immunomodulation that may impact post-operative recovery. This study soughs to assess the association between RBCT and post-hepatectomy morbidity.

Methods:

Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) registry, we identified all adult patients undergoing elective hepatectomy over 2007-2012. Two exposure groups were created based on RBCT. Primary outcomes were 30-day major morbidity and mortality. Secondary outcomes included 30-day system-specific morbidity and length of stay (LOS). Relative risks (RR) with 95% confidence interval (95% CI) were computed using regression analyses. Sensitivity analyses were conducted to understand how missing data might have impacted the results.

Results:

A total of 12,180 patients were identified. Of those, 11,712 met inclusion criteria, 2,951 (25.2%) of whom received RBCT. Major morbidity occurred in 14.9% of patients and was strongly associated with RBCT (25.3% vs. 11.3%; P<0.001). Transfused patients had higher rates of 30-day mortality (5.6% vs. 1.0%; P<0.0001). After adjustment for baseline and clinical characteristics, RBCT was independently associated with increased major morbidity (RR 1.80; 95% CI: 1.61-1.99), mortality (RR 3.62; 95% CI: 2.68-4.89), and 1.29 times greater LOS (RR 1.29; 95% CI: 1.25-1.32). Results were robust to a number of sensitivity analyses for missing data.

Conclusions:

Perioperative RBCT for hepatectomy was independently associated with worse short-term outcomes and prolonged LOS. These findings further the rationale to focus on minimizing RBCT for hepatectomy, when they can be avoided.

KEYWORDS:

Transfusion; bleeding; blood; hepatectomy; liver; red blood cells

Conflict of interest statement

Conflicts of Interest: This work has been presented as poster presentation at the 2015 Canadian Surgery Forum in Qu├ębec City, in September 2015.

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