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Cir Esp. 2018 Nov;96(9):546-554. doi: 10.1016/j.ciresp.2018.03.010.

Perioperative transfusion management in gastric cancer surgery: Analysis of the Spanish subset of the EURECCA oesophago-gastric cancer registry.

[Article in English, Spanish]

Author information

1
Servicio de Cirugía, Hospital Universitario Mútua Terrassa,, Terrassa, Barcelona, España. Electronic address: javier_osorio2003@yahoo.es.
2
Servicio de Medicina Interna, Hospital de Sant Joan Despi Moisés Broggi, Sant Joan Despí, Barcelona, España; Anemia Working Group España.
3
Servicio de Cirugía, Complejo Hospitalario de Navarra, Pamplona, España.
4
Servicio de Cirugía, Hospital Germans Trias i Pujol, Badalona, Barcelona, España.
5
Servicio de Cirugía, Hospital Parc Taulí, Sabadell, Sabadell, Barcelona, España.
6
Servicio de Cirugía, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
7
Servicio de Cirugía, Hospital Universitario Arnau de Vilanova, Lleida, España.
8
Servicio de Cirugía, Hospital Universitari de Girona Dr. Josep Trueta, Girona, España.
9
Servicio de Cirugía, Hospital Universitario Mútua Terrassa,, Terrassa, Barcelona, España.
10
Servicio de Cirugía, Hospital Universitari Vall d'Hebrón, Barcelona, España.
11
Servicio de Cirugía, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Barcelona, España.
12
Servicio de Cirugía, Hospital General de Granollers, Granollers, Barcelona, España.
13
Servicio de Cirugía, Hospital Universitari de Tarragona Joan XXIII, Tarragona, España.
14
Servicio de Cirugía Gastrointestinal, Hospital Clínic, Barcelona, España.
15
Servicio de Cirugía, Consorci Sanitari de Terrassa, Terrassa, Barcelona, España.
16
Servicio de Cirugía, Hospital de Sant Joan Despi Moisés Broggi, Sant Joan Despí, Barcelona, España.
17
Servicio de Cirugía, Hospital de Sant Joan de Déu de Martorell, Martorell, Barcelona, España.
18
Departamento de Epidemiología, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, Estados Unidos.
19
Unidad de Aféresis, Departamento de Hemoterapia y Hemostasia, Hospital Clinic, Barcelona, España.
20
Sección de Cirugía Gastrointestinal, Hospital Universitari del Mar, Barcelona, España.

Abstract

INTRODUCTION:

This study evaluated allogenic packed red blood cell (aPRBC) transfusion rates in patients undergoing resection for gastric cancer and the implementation of blood-saving protocols (BSP).

METHODS:

Retrospective study of all gastric cancer patients operated on with curative intent in Catalonia and Navarra (2011-2013) and included in the Spanish subset of the EURECCA Oesophago-Gastric Cancer Registry. Hospitals with BSP were defined as those with a preoperative haemoglobin (Hb) optimisation circuit associated with restrictive transfusion strategies. Predictors of aPRBC transfusion were identified by multinomial logistic regression analysis.

RESULTS:

A total of 652 patients were included, 274 (42.0%) of which received aPRBC transfusion. Six of the 19 participating hospitals had BSP and treated 145 (22.2%) patients. Low Hb level at diagnosis (10 vs 12.4g/dL), ASA score III/IV, pT3-4, open surgery, associated visceral resection, and having being operated on in a hospital without BSP were predictors of aPRBC transfusion, while low Hb level, associated visceral resection, and non-BSP hospital remained predictors in the multivariate analysis. In case of comparable risk factors for aPRBC transfusion, there was a higher use of preoperative intravenous iron treatment (26.2% vs 13.2%) and a lower percentage of transfusions (31.7% vs 45%) in hospitals with BSP.

CONCLUSIONS:

The perioperative transfusion rate in gastric cancer was 42%. Hospitals with BSP showed a significant reduction of blood transfusions but treated only 22% of patients. Main predictors of aPRBC were low Hb level, associated visceral resection, and undergoing surgery at a hospital without BSP.

KEYWORDS:

Blood transfusion; Cirugía; Cáncer gástrico; Gastric cancer; Hierro intravenoso; Intravenous iron; Surgery; Transfusión sanguínea

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