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. 2017 Feb;35(2):38.e17-38.e24.
doi: 10.1016/j.urolonc.2016.09.005. Epub 2016 Oct 19.

Longer average blood storage duration is associated with increased risk of infection and overall morbidity following radical cystectomy

Meera R Chappidi  1 , Heather J Chalfin  2 , Daniel J Johnson  3 , Max Kates  2 , Nikolai A Sopko  2 , Michael H Johnson  2 , Jen-Jane Liu  4 , Steven M Frank  3 , Trinity J Bivalacqua  2
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Longer average blood storage duration is associated with increased risk of infection and overall morbidity following radical cystectomy

Meera R Chappidi et al. Urol Oncol. 2017 Feb.

Abstract

Background: Patients with bladder cancer undergoing radical cystectomy (RC) experience high rates of perioperative blood transfusions (PBTs) and morbidity. The aim of this study was to evaluate the effect of blood storage duration on the risk of adverse perioperative outcomes in this high-risk patient population.

Materials and methods: In a retrospective review of RC patients from 2010 to 2014 who received PBTs, the average storage duration for all units transfused was used to classify patients as receiving older blood using 3 different definitions (≥21 days,≥28 days, and≥35 days). Multivariable Poisson regression models were used to determine the adjusted relative risk of perioperative infections and overall morbidity in those given older blood compared to fresher blood.

Results: Of the 451 patients undergoing RC, 205 (45%) received nonirradiated PBTs. In multivariable modeling, increasing average blood storage duration, as a continuous variable, was associated with an increased risk of infections (risk ratio [RR] = 1.08 per day, 95% CI: 1.01-1.17) and overall morbidity (RR = 1.08 per day, 95% CI: 1.01-1.15). Furthermore, ≥28-day blood storage (vs.<28) was associated with increased infections (RR = 2.69, 95% CI: 1.18-6.14) and morbidity (RR = 2.54, 95% CI: 1.31-4.95), and ≥35-day blood storage (vs.<35) was also associated with increased infections (RR = 2.83, 95% CI: 1.42-5.66) and morbidity (RR = 3.35, 95% CI: 1.95-5.77).

Conclusions: Although blood is stored up to 42 days, storage≥28 days may expose RC patients to increased perioperative infections and overall morbidity compared with storage<28 days. Prospective cohort studies are warranted in cystectomy and other high-risk surgical oncology patients to better determine the effect of blood storage duration.

Keywords: Bladder cancer; Blood transfusion; Cystectomy; Infection; Postoperative complications.

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Conflict of interest statement

S.M.F. has been on advisory boards for Haemonetics, Medtronic and Zimmer-Biomet, companies involved with patient blood management. All other authors declare that they have no conflicts of interest relevant to this manuscript.

Figures

Figure 1
Figure 1
Relative risk and 95% confidence intervals (error bars) for composite morbidity and infection using 21, 28, and 35-day definitions of older blood calculated by multivariable Poisson regression with robust variance estimate models
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