TY - JOUR
T1 - Perioperative Blood Transfusions Are Associated with Worse Overall Survival but Not Disease-Free Survival after Curative Rectal Cancer Resection
T2 - A Propensity Score-Matched Analysis
AU - Hanna, David N.
AU - Gamboa, Adriana C.
AU - Balch, Glen C.
AU - Regenbogen, Scott E.
AU - Holder-Murray, Jennifer
AU - Abdel-Misih, Sherif R.Z.
AU - Silviera, Matthew L.
AU - Feng, Michael P.
AU - Stewart, Thomas G.
AU - Wang, Li
AU - Hawkins, Alexander T.
N1 - Funding Information:
Funding/Support: Dr Hawkins was supported by the National Institute of Diabetes and Digestive and Kidney Disease of the National Institutes of Health under award No. K23DK118192. The project described was supported by the National Center for Research Resources grant UL1 RR024975-01 and is now at the National Center for Advancing Translational Sciences grant 2 UL1 TR000445-06. Additional support was provided by Clinical and Translational Science Awards program award UL1 TR002243 from the National Center for Advancing Translational Sciences.
Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/8/1
Y1 - 2021/8/1
N2 - BACKGROUND: The effects of blood transfusions on oncologic outcomes after surgery remain inconclusive. Thus, we examined the association between receiving a perioperative blood transfusion and oncologic outcomes in patients undergoing curative rectal cancer resection. OBJECTIVE: The purpose of this study was to assess the association between receiving a perioperative blood transfusion with disease-free and overall survival in patients undergoing curative resection of clinical stage I to III rectal cancer. We hypothesized that blood transfusion is associated with worse disease-free and overall survival in this patient cohort. DESIGN: This was a retrospective cohort study using a propensity score-matched analysis. SETTINGS: The study involved 6 tertiary academic medical centers in the United States contributing to the United States Rectal Cancer Consortium. PATIENTS: Patients who underwent curative resection for rectal cancer from 2010 to 2018 were included. MAIN OUTCOME MEASURES: The primary outcome was disease-free survival. The secondary outcomes were overall survival, intensive care unit length of stay, hospital length of stay, surgical site infection, and readmission. RESULTS: Of the 924 patients eligible for matching, 312 patients were matched, including 100 patients who received a transfusion and 212 who did not. In a propensity score-matched analysis, receiving a perioperative blood transfusion was not associated with worse 5-year disease-free survival (transfused, 78%; not transfused, 83%; p = 0.32) but was associated with worse 5-year overall survival (transfused 65% vs not transfused 86%; p < 0.001) and increased hospital length of stay (transfused, 9.9 d; not transfused, 7.6 d; p = 0.001). LIMITATIONS: Despite propensity matching, confounding may remain. Propensity matching may limit the power to detect a difference in disease-free survival. CONCLUSIONS: Receiving a perioperative blood transfusion is not associated with worse disease-free survival but is associated with worse overall survival. Such findings are important for clinicians and patients to understand when considering perioperative blood transfusions. See Video Abstract at http://links.lww.com/DCR/B531.
AB - BACKGROUND: The effects of blood transfusions on oncologic outcomes after surgery remain inconclusive. Thus, we examined the association between receiving a perioperative blood transfusion and oncologic outcomes in patients undergoing curative rectal cancer resection. OBJECTIVE: The purpose of this study was to assess the association between receiving a perioperative blood transfusion with disease-free and overall survival in patients undergoing curative resection of clinical stage I to III rectal cancer. We hypothesized that blood transfusion is associated with worse disease-free and overall survival in this patient cohort. DESIGN: This was a retrospective cohort study using a propensity score-matched analysis. SETTINGS: The study involved 6 tertiary academic medical centers in the United States contributing to the United States Rectal Cancer Consortium. PATIENTS: Patients who underwent curative resection for rectal cancer from 2010 to 2018 were included. MAIN OUTCOME MEASURES: The primary outcome was disease-free survival. The secondary outcomes were overall survival, intensive care unit length of stay, hospital length of stay, surgical site infection, and readmission. RESULTS: Of the 924 patients eligible for matching, 312 patients were matched, including 100 patients who received a transfusion and 212 who did not. In a propensity score-matched analysis, receiving a perioperative blood transfusion was not associated with worse 5-year disease-free survival (transfused, 78%; not transfused, 83%; p = 0.32) but was associated with worse 5-year overall survival (transfused 65% vs not transfused 86%; p < 0.001) and increased hospital length of stay (transfused, 9.9 d; not transfused, 7.6 d; p = 0.001). LIMITATIONS: Despite propensity matching, confounding may remain. Propensity matching may limit the power to detect a difference in disease-free survival. CONCLUSIONS: Receiving a perioperative blood transfusion is not associated with worse disease-free survival but is associated with worse overall survival. Such findings are important for clinicians and patients to understand when considering perioperative blood transfusions. See Video Abstract at http://links.lww.com/DCR/B531.
KW - Blood transfusions
KW - Outcomes
KW - Perioperative care
KW - Propensity score
KW - Rectal cancer
UR - http://www.scopus.com/inward/record.url?scp=85109880872&partnerID=8YFLogxK
U2 - 10.1097/DCR.0000000000002006
DO - 10.1097/DCR.0000000000002006
M3 - Article
C2 - 34214054
AN - SCOPUS:85109880872
SN - 0012-3706
VL - 64
SP - 946
EP - 954
JO - Diseases of the Colon and Rectum
JF - Diseases of the Colon and Rectum
IS - 8
ER -