Red blood cell transfusion rate correlates with risk for morbidity, mortality
Higher red blood cell transfusion rates correlated with higher odds for morbidity and mortality among patients who underwent elective GI cancer resection, according to a presentation at Digestive Disease Week.
“Patients who undergo GI surgery are at a higher risk of developing perioperative anemia given their need for major operations with potentially significant blood loss. Perioperative anemia is most often treated with red blood cell transfusions (RBCT) and, as such, up to 85% of GI cancer patients are transfused in the perioperative period,” Jesse Zuckerman, MSc, University of Toronto, said. “While anemia itself carries risks of post-operative morbidity and mortality, RBCTs have as well been independently associated with the inferior outcomes; monitoring of transfusions is therefore critical. Yet, considerable variation in transfusion practice has been observed in various settings and amongst several patient populations.”
In a population-based, retrospective cohort study, researchers analyzed 59,964 patients (median age, 69 years; 43.2% women) who underwent elective GI cancer resection to investigate the association between surgeon-variation transfusion practice (n = 616 surgeons) and hospital-variation transfusion practice (n = 81 hospitals) with patient mortality. Hierarchical logistic regression models estimated adjusted RBCT and 90-day morbidity or mortality rates for each surgeon and hospital.
According to study results, 18% of patients received RBCT, adjusted rates for RBCT varied significantly among surgeons (7.4%-36.4%) and hospitals (8.4%-30%). For every 10% increase in RBCT rate at the surgeon-level, researchers observed a 4% increase in 90-day major morbidity; hospital-level RBCT rates were not significantly associated with major morbidity. Similarly, 90-day mortality rates increased by 0.3% for every 10% increase in RBCT rate at both the surgeon-level and the hospital-level.
“After adjusting for case mix, patients of surgeons who transfused fewer patients overall had better outcomes,” Zuckerman concluded. “Better transfusion practice is an actionable target to improve patient outcomes, limit the use of scarce resources and reduce healthcare costs. This study highlights important information that should support the development of system-level efforts aimed at reducing transfusion practice variation and minimizing RBCTs with an overarching goal of improving the quality of cancer care.”
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Zuckerman J, et al. Abstract 326. Presented at: Digestive Disease Week; May 21-23, 2021 (virtual meeting).
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