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. 2015 Jan;136(1):65-70.
doi: 10.1016/j.ygyno.2014.11.009. Epub 2014 Nov 14.

Perioperative blood transfusion in gynecologic oncology surgery: analysis of the National Surgical Quality Improvement Program Database

Lauren S Prescott  1 , Thomas A Aloia  2 , Alaina J Brown  3 , Jolyn S Taylor  3 , Mark F Munsell  4 , Charlotte C Sun  3 , Kathleen M Schmeler  3 , Charles F Levenback  3 , Diane C Bodurka  3
Affiliations

Perioperative blood transfusion in gynecologic oncology surgery: analysis of the National Surgical Quality Improvement Program Database

Lauren S Prescott et al. Gynecol Oncol. 2015 Jan.

Abstract

Objective: To use a large-scale multi-institutional dataset to quantify the prevalence of packed red blood cell transfusions and examine the associations between transfusion and perioperative outcomes in gynecologic cancer surgery.

Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) participant use file was queried for all gynecologic cancer cases between 2010 and 2012. Demographic, preoperative and intraoperative variables were compared between transfusion and non-transfusion groups using chi-squared, Fisher's exact and Wilcoxon rank-sum tests. The primary endpoint was 30-day composite morbidity. Secondary endpoints included composite surgical site infections, mortality and length of stay.

Results: A total of 8519 patients were analyzed, and 13.8% received a packed red blood cell transfusion. In the multivariate analysis, after adjusting for key clinical and perioperative factors, including preoperative anemia and case magnitude, transfusion was associated with higher composite morbidity (OR = 1.85, 95% CI 1.5-2.24), surgical site infections (OR 1.80, 95% CI 1.39-2.35), mortality (OR 3.38, 95% CI 1.80-6.36) and length of hospital stay (3.02 days v. 7.17 days, P < 0.001).

Conclusions: Blood transfusions are associated with increased surgical wound infections, composite morbidity and mortality. Based on our analysis of the NSQIP database, transfusion practices in gynecologic cancer should be scrutinized. Examination of institutional practices and creation of transfusion guidelines for gynecologic malignancies could potentially result in better utilization of blood bank resources and clinical outcomes among patients.

Keywords: Blood utilization; Gynecologic oncology; NSQIP; Perioperative outcomes; Transfusion.

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Conflict of interest statement

The authors have no conflicts of interest.

Figures

Figure 1
Figure 1
Forest plot of risk of 30-day postoperative outcomes by transfusion status. Odds ratios and 95% confidence intervals from univariate analysis of 30-day postoperative outcomes as a function of risk group (transfusion status), with number (%) of events by risk group
Figure 2
Figure 2
Forest plots displaying multivariate logistic regression analysis for composite morbidity, composite surgical site infection and mortality. Adjusted odds ratios and 95% confidence intervals from multivariate analysis of morbidity, composite surgical site infection, and mortality as a function of various risks, with number of patients and events in each risk group
See this image and copyright information in PMC

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