Preoperative Transfusion for Anemia in Patients Undergoing Abdominal Surgery for Malignancy

Background Transfusion guidelines have been established for severe anemia, but limited data is available regarding the utility of preoperative transfusion. This study evaluates the predictive factors and relative value of preoperative transfusion in oncologic patients with moderate anemia undergoing abdominal surgery. Methods Using the American College of Surgeons National Surgical Quality Improvement Program database, adult patients with moderate anemia (hematocrit 21-27%) who underwent non-emergent abdominal oncologic resection from 2005 to 2017 were identified. Preoperative transfusion and non-transfused patients were propensity score matched based on baseline covariates. Outcomes were compared using univariate and Poisson regression analysis. Results Of 6222 patients, preoperative transfused (N = 1000, 16.1%) patients were more likely to have bleeding disorders (12.1% vs 6.7%,p < 0.0001) and baseline thrombocytopenia (12% vs 7.3%,p < 0.0001) and had shorter operative length (< 180 min: 69.4% vs 59.8%,p < 0.0001). After matching (N = 987/group), preoperative transfusion was associated with higher rates of intraoperative/postoperative transfusion (odds ratio 1.24,p0.017) and surgical site infections (odds ratio 1.67,p0.004) and longer length of stay (incidence rate ratio 1.06,p < 0.0001). Conclusions Preoperative transfusion is associated with increased surgical site infections and longer hospital stay and should be carefully considered in oncologic patients given the absence of improvement in outcomes.

Automated summary

This study found that preoperative transfusion in oncologic patients undergoing abdominal surgery is associated with increased surgical site infections and longer hospital stay, highlighting the importance of carefully considering the need for transfusion in these patients.