Hong Sunghee, Jung Yun Kyung, Kim Seonju, Yoon Junghyun, Choi Dongho, Park Boyoung
Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea.
Department of Statistics and Data Science, Graduate School, Dongguk University, Seoul, Korea.
Ann Hepatobiliary Pancreat Surg. 2025 Aug 31;29(3):334-342. doi: 10.14701/ahbps.25-072. Epub 2025 Jul 29.
BACKGROUNDS/AIMS: This study investigated perioperative patterns of red blood cell (RBC) transfusion and related determinants in pancreatic cancer surgery using a nationwide Korean database.
We assessed data from the National Health Insurance Service (NHIS) from 2012 to 2020, including newly diagnosed pancreatic cancer patients aged ≥ 20 years who underwent pancreatic surgery within one-year of their diagnosis. Perioperative RBC transfusion was defined as receiving ≥ 1 unit of allogenic RBCs from one week before surgery through hospital discharge.
Of the 10,473 patients, 18% underwent perioperative RBC transfusions. The transfusion rate declined from 20.1% in 2012 to 12.7% in 2015, followed by an increase to 19.9% in 2020. In a multivariate analysis, each 10-year increase in age (odds ratio [OR], 1.30; 95% confidence interval [CI], 1.24-1.37), female sex (OR, 1.16; 95% CI, 1.05-1.29), and being in the lowest-income quartile compared to the highest (OR, 1.29; 95% CI, 1.11-1.49) were associated with an increased likelihood of requiring RBC transfusions. A higher Charlson comorbidity index was independently connected to a greater risk as well. Compared with pancreaticoduodenectomy, total pancreatectomy had higher odds (OR, 1.91; 95% CI, 1.56-2.35), whereas distal pancreatectomy had lower odds. Furthermore, general hospitals, compared with tertiary hospitals, were associated with higher transfusion probability (OR, 1.38; 95% CI, 1.22-1.56).
Given rising RBC transfusion rates among low-income patients and limited NHIS coverage for new transfusion-sparing methods, Korea should prioritize broader adoption of multidisciplinary blood management over continued reliance on transfusion.
背景/目的：本研究利用韩国全国性数据库调查了胰腺癌手术中红细胞（RBC）输血的围手术期模式及相关决定因素。
我们评估了2012年至2020年期间韩国国民健康保险服务（NHIS）的数据，包括年龄≥20岁、在确诊后一年内接受胰腺手术的新诊断胰腺癌患者。围手术期红细胞输血定义为从手术前一周至出院接受≥1单位异体红细胞。
在10473例患者中，18%接受了围手术期红细胞输血。输血率从2012年的20.1%下降至2015年的12.7%，随后在2020年又升至19.9%。在多因素分析中，年龄每增加10岁（优势比[OR]，1.30；95%置信区间[CI]，1.24 - 1.37）、女性（OR，1.16；95%CI，1.05 - 1.29）以及与最高收入四分位数相比处于最低收入四分位数（OR，1.29；95%CI，1.11 - 1.49）均与需要红细胞输血的可能性增加相关。较高的Charlson合并症指数也独立地与更高风险相关。与胰十二指肠切除术相比，全胰切除术的优势比更高（OR，1.91；95%CI，1.56 - 2.35），而远端胰腺切除术的优势比更低。此外，与三级医院相比，综合医院的输血概率更高（OR，1.38；95%CI，1.22 - 1.56）。
鉴于低收入患者红细胞输血率上升以及NHIS对新的输血节省方法的覆盖有限，韩国应优先更广泛地采用多学科血液管理，而非继续依赖输血。
