Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada.
Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.
Ann Surg Oncol. 2021 Jan;28(1):29-38. doi: 10.1245/s10434-020-09291-y. Epub 2020 Nov 9.
Gastrointestinal cancer surgery patients often develop perioperative anemia commonly treated with red blood cell (RBC) transfusions. Given the potential associated risks, evidence published over the past 10 years supports restrictive transfusion practices and blood conservation programs. Whether transfusion practices have changed remains unclear. We describe temporal RBC transfusion trends in a large North American population who underwent gastrointestinal cancer surgery.
We conducted a population-based retrospective cohort study of patients who underwent gastrointestinal cancer resection between 2007 and 2018 using health administrative datasets. The outcome was RBC transfusion during hospitalization. Temporal transfusion trends were analyzed with Cochran-Armitage tests. Multivariable regression assessed the association between year of diagnosis and likelihood of RBC transfusion while controlling for confounding.
Of 79,764 patients undergoing gastrointestinal cancer resection, the median age was 69 years old (interquartile range (IQR) 60-78 years) and 55.5% were male. The most frequent procedures were colectomy (52.8%) and proctectomy (23.0%). A total of 18,175 patients (23%) received RBC transfusion. The proportion of patients transfused decreased from 26.5% in 2007 to 18.9% in 2018 (p < 0.001). After adjusting for patient, procedure, and hospital factors, the most recent time period (2015-2018) was associated with a reduced likelihood of receiving RBC transfusion [relative risk 0.86 (95% confidence interval: 0.83-0.89)] relative to the intermediate time period (2011-2014).
Over 11 years, we observed decreased RBC transfusion use and reduced likelihood of transfusion in patients undergoing gastrointestinal cancer resection. This information provides a foundation to further examine transfusion appropriateness or explore if additional transfusion minimization in surgical patients can be achieved.
胃肠道癌症手术患者常发生围手术期贫血，通常采用输注红细胞（RBC）进行治疗。鉴于潜在的相关风险，过去 10 年来发表的证据支持限制输血实践和血液保护方案。输血实践是否发生改变尚不清楚。我们描述了在接受胃肠道癌症手术的大型北美人群中 RBC 输注的时间趋势。
我们使用健康管理数据集，对 2007 年至 2018 年间接受胃肠道癌症切除术的患者进行了一项基于人群的回顾性队列研究。结局是住院期间的 RBC 输注。采用 Cochran-Armitage 检验分析时间趋势。多变量回归评估了诊断年份与 RBC 输注可能性之间的关联，同时控制了混杂因素。
在接受胃肠道癌症切除术的 79764 例患者中，中位年龄为 69 岁（四分位距 60-78 岁），55.5%为男性。最常见的手术是结肠切除术（52.8%）和直肠切除术（23.0%）。共有 18175 例（23%）患者接受 RBC 输注。接受输血的患者比例从 2007 年的 26.5%降至 2018 年的 18.9%（p<0.001）。在调整患者、手术和医院因素后，最近的时间段（2015-2018 年）与接受 RBC 输注的可能性降低相关[相对风险 0.86（95%置信区间：0.83-0.89）]，与中间时间段（2011-2014 年）相比。
在 11 年期间，我们观察到胃肠道癌症切除术患者的 RBC 输注减少，输血可能性降低。这些信息为进一步检查输血的适当性或探索是否可以在手术患者中进一步减少输血提供了基础。
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