Retrospective Cohort Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2019; 7(10): 1093-1102
Published online May 26, 2019. doi: 10.12998/wjcc.v7.i10.1093
Impact of perioperative transfusion in patients undergoing resection of colorectal cancer liver metastases: A population-based study
Bo Long, Zhen-Nan Xiao, Li-Hua Shang, Bo-Yan Pan, Jun Chai
Bo Long, Zhen-Nan Xiao, Li-Hua Shang, Bo-Yan Pan, Jun Chai, Department of Anesthesiology, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China
Bo-Yan Pan, Department of Anesthesiology, Shenyang Women’s and Children’s Hospital, Shenyang 110011, Liaoning Province, China
Author contributions: Long B conceptualized and designed the study, analyzed and interpreted the data, drafted the manuscript, and approved the final manuscript; Xiao ZN acquired the data, drafted the manuscript, and approved the manuscript; Shang LH collected the data, performed statistical analysis, and approved the manuscript; Pan BY acquired the data, guaranteed the integrity of the entire study, revised the study, and approved the final manuscript; Chai J conceptualized and designed the study, analyzed and interpreted the data, and approved the final manuscript.
Conflict-of-interest statement: The authors disclose no conflicts of interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jun Chai, MD, PhD, Department of Anesthesiology, Shengjing Hospital, China Medical University, No. 36, Sanhao Street, Shenyang 110004, Liaoning Province, China. chaij@sj-hospital.org
Telephone: +86-24-23892617 Fax: +86-24-23892617
Received: February 3, 2019
Peer-review started: February 6, 2019
First decision: March 5, 2019
Revised: March 24, 2019
Accepted: May 1, 2019
Article in press: May 1, 2019
Published online: May 26, 2019
Processing time: 113 Days and 2.1 Hours
ARTICLE HIGHLIGHTS
Research background

Since perioperative allogeneic blood transfusion is associated with poorer outcomes, the risk of blood transfusion is high, including allergic reactions, infectious diseases, acute or delayed hemolytic reaction, and transfusion-related immune modulation. Previous studies have shown that perioperative allogeneic blood transfusion was associated with poor outcomes, such as increased postoperative complications and mortality. Patients with malignant tumors undergoing surgery often showed anemia. The amount of blood loss during surgery may be large, so the blood transfusion threshold is relatively low.

Research motivation

The use of allogeneic blood transfusion during surgery can improve outcomes and save countless lives. However, blood transfusions have higher risks, such as allergic reactions, infectious diseases, acute or delayed hemolysis, and transfusion-related immune regulation.

Research objectives

Based on above motivation, the study was designed to determine factors associated with perioperative blood transfusions and to examine the effects of perioperative blood transfusions on patients with colorectal cancer (CRC) metastasis undergoing liver resection.

Research methods

A total of 2018 patients were included from The United States National Inpatient Sample database, of whom 480 had a perioperative transfusion. Comorbidities such as chronic anemia, congestive heart failure, chronic pulmonary disease, diabetes, hypertension, obesity, and renal failure were used.

Research results

Emergency admission, hepatectomy, and chronic anemia were significantly positively associated with the chance of receiving a blood transfusion, but there was a significant negative correlation between the chances of undergoing surgery and receiving blood transfusions at teaching hospitals. Perioperative blood transfusions were significantly associated with increased in-hospital mortality, overall increase in postoperative complications, and prolonged hospital stay.

Research conclusions

The results of this study demonstrated that in addition to hepatic lobectomy, emergency admission, chronic anemia, and surgery at a non-teaching hospital are more likely to receive a perioperative transfusion. In addition, the study provides an initial hit that patients with liver metastases who undergo perioperative transfusion are at a higher risk of hospital mortality, postoperative complications, and longer hospital stays.

Research perspectives

Based on this study, patients with liver metastasis who undergo tumor resection have a higher chance of receiving a blood transfusion, and a higher risk of hospital mortality. In future studies, it is worthwhile to continue to study the impact of liver resection area and extent on mortality in CRC patients.