A Comprehensive Assessment of Transfusion in Elective Pancreatectomy: Risk Factors and Complications
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2012 SSAT POSTER PRESENTATION
A Comprehensive Assessment of Transfusion in Elective Pancreatectomy: Risk Factors and Complications Raphael C. Sun & Anna M. Button & Brian J. Smith & Richard F. Leblond & James R. Howe & James J. Mezhir
Received: 7 November 2012 / Accepted: 8 February 2013 / Published online: 20 February 2013 # 2013 The Society for Surgery of the Alimentary Tract
Abstract 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. Keywords Transfusion . Pancreatectomy . Complications . Pancreatic cancer . Pancreatitis
Abbreviations RBC ACS-NSQIP
This paper was presented in part at the Society for Surgery of the Alimentary Tract 53rd annual meeting May 2012, San Diego, California.
CT ASA
R. C. Sun : J. R. Howe : J. J. Mezhir Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA A. M. Button : B. J. Smith Epidemiology and Biostatistics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA R. F. Leblond Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA J. J. Mezhir (*) Division of Surgical Oncology and Endocrine Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive; 4642 JCP, Iowa City, IA 52242, USA e-mail: [email protected]
Red blood cell American College of Surgeons National Surgical Quality Improvement Program Computed tomography American Society of Anesthesiology
Introduction There is increased awareness as to the negative consequences of red blood cell (RBC) transfusion in noncardiac, general surgical procedures.1
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