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. 2024 Sep 25:63:728-735.
doi: 10.2340/1651-226X.2024.40435.

Safe to save blood in ovarian cancer surgery - time to change transfusion habits

Anna Norbeck  1 , Jesper Bengtsson  2 , Susanne Malander  3 , Mihaela Asp  4 , Päivi Kannisto  4
Affiliations

Safe to save blood in ovarian cancer surgery - time to change transfusion habits

Anna Norbeck et al. Acta Oncol. .

Abstract

Background: Patients with advanced ovarian cancer (AOC) undergoing surgery are often subjected to red blood cell (RBC) transfusions. Both anemia and RBC transfusion are associated with increased morbidity. The aim was to evaluate patient recovery after the implementation of patient blood management (PBM) strategies.

Methods: This retrospective cohort study included 354 patients with AOC undergoing surgery at Skane University Hospital Lund, Sweden, between January 2016 and December 2021. The gradual implementation of PBM strategies included restrictive RBC transfusion, tranexamic acid as standard medication before laparotomies and intravenous iron administered to patients with iron deficiency. Severe complications were defined as Clavien-Dindo (CD) grade ≥ 3a. Logistic and linear regression analyses were used to evaluate the differences between three consecutive periods.

Results: After the implementation of new strategies, 52% of the patients had at least one transfusion compared to 83% at baseline (p < 0.001). There was no difference in the rate of severe complications (CD ≥ 3a) between the groups, adjusted odds ratio 0.55 (95% CI 0.26-1.17). The mean difference in hemoglobin before chemotherapy was -1.32 g/L (95% CI -3.04 to -0.22) when adjusted for blood loss and days from surgery to chemotherapy. The length of stay (LOS) decreased from 8.5 days to 7.5 days (p 0.002).

Interpretation: The number of patients transfused were reduced by 31%. Despite a slight increase in anemia rate, severe complications (CD ≥ 3a) remained stable. The LOS was reduced, and chemotherapy was given without delay, indicating that PBM is feasible and without causing major severe effects on short-term recovery.

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Conflict of interest statement

Research grants for this study were obtained from Pharmacosmos; they were not involved in the planning of the study, the conduct of the study or the interpretation of the data.

Figures

Figure 1
Figure 1
Flow chart of the study population.
Figure 2
Figure 2
Gradual implementation of patient blood management clinical routines, including restrictive red blood cell transfusion, administration of tranexamic acid and administration of intravenous iron.
Figure 3
Figure 3
Percentage of patients transfused with units of red blood cells in the three consecutive periods.
See this image and copyright information in PMC

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