Impact of perioperative transfusion in patients undergoing resection of colorectal cancer liver metastases: A population-based study

Table 1 Characteristics of the study population (unweighted n = 2018, weighted n = 9991)

	Total	No transfusion	Perioperative transfusion	P-value1
	n = 2018	n = 1538	n = 480
Demographic data
Age
<70 yr	1532 (76.04)	1195 (77.88)	337 (70.12)	0.0004a
≥70 yr	486 (23.96)	343 (22.12)	143 (29.88)
Sex
Male	1112 (55.10)	870 (56.59)	242 (50.32)	0.01a
Female	903 (44.90)	665 (43.41)	238 (49.68)
Race
White	1251 (76.29)	955 (76.94)	296 (74.22)	0.10
Black	175 (10.53)	121 (9.63)	54 (13.32)
Hispanic	115 (7.07)	86 (7.04)	29 (7.16)
Asian/Pacific	55 (3.32)	40 (3.21)	15 (3.62)
Others	46 (2.80)	39 (3.16)	7 (1.68)
Household income
Q1	484 (24.34)	355 (23.59)	129 (26.90)	0.14
Q2	473 (23.79)	369 (24.34)	104 (22.06)
Q3	471 (23.93)	372 (24.89)	99 (20.87)
Q4	541 (27.93)	400 (27.22)	141 (30.16)
Type of admission
Elective	1676 (83.35)	1311 (85.59)	365 (76.12)	<0.0001a
Emergency	338 (16.65)	224 (14.41)	114 (23.88)
Insurance status
Medicare/Medicaid	877 (43.31)	628 (40.62)	249 (51.97)	<0.0001a
Private including HMO	1027 (51.05)	816 (53.25)	211 (43.95)
Self-pay/no charge/other	114 (5.65)	94 (6.13)	20 (4.07)
Clinical data
Hepatic precondition
No	1967 (97.41)	1494 (97.07)	473 (98.52)	0.24
Steatosis/fibrosis	44 (2.23)	38 (2.52)	6 (1.29)
Cirrhosis	7 (0.36)	6 (0.41)	1 (0.19)
Primary tumor site
Colon	1595 (79.04)	1194 (77.64)	401 (83.59)	0.003a
Rectum	423 (20.95)	344 (22.36)	79 (16.40)
Extent of liver resection
Partial hepatectomy	1541 (76.46)	1204 (78.39)	337 (70.19)	<0.0001a
Hepatic lobectomy	477 (23.54)	334 (21.60)	143 (29.81)
Laparoscopic procedure
No	1971 (97.64)	1498 (9737.)	473 (98.52)	0.15
Yes	47 (2.36)	40 (2.63)	7 (1.48)
Robotic-assisted
No	2010 (99..59)	14532 (99.59)	478 (99.56)	0.91
Yes	8 (0.41)	6 (0.40)	2 (0.43)
Comorbidity
Chronic anemia	422 (20.71)	247 (15.87)	175 (36.37)	<0.0001a
Congestive heart failure	59 (2.95)	35 (2.31)	24 (5.02)	0.002a
Chronic pulmonary disease	188 (9.26)	135 (8.72)	53 (11.02)	0.12
Diabetes	293 (14.32)	221 (14.16)	72 (14.84)	0.70
Hypertension	848 (41.82)	625 (40.43)	223 (46.32)	0.02a
Obesity	118 (5.85)	89 (5.80)	29 (6.02)	0.86
Renal failure	39 (1.89)	30 (1.936)	9 (1.79)	0.86
Hospital data
Hospital bed size
Small	212 (10.21)	162 (10.28)	50 (9.97)	0.007a
Medium	327 (16.58)	227 (15.15)	100 (21.12)
Large	1453 (73.22)	1125 (74.56)	328 (68.91)
Location of hospital
Rural	77 (3.71)	62 (3.89)	15 (3.14)	0.34
Urban	1915 (96.29)	1452 (96.10)	463 (96.87)
Teaching status of hospital
Non-teaching	419 (20.65)	284 (18.46)	135 (27.64)	<0.0001a
Teaching	1573 (79.35)	1230 (81.54)	343 (72.36)
Region of hospital
Northeast	437 (22.65)	351 (23.79)	86 (18.97)	0.11
Midwest	480 (23.71)	360 (23.27)	120 (25.11)
South	737 (35.65)	566 (35.99)	171 (34.53)
West	364 (17.98)	261 (16.94)	103 (21.39)

Data are presented as unweighted counts (weighted proportion). Percentages may not add up to 100% due to missing data. Q1: 0-25^th percentile; Q2: 26^th to 50^th percentile; Q3: 51^st to 75^th percentile; Q4: 76^th to 100^th percentile.

¹χ² test.

^aP < 0.05, non-transfusion group vs transfusion group.

Table 2 Associations between perioperative transfusion and factors of interest

	OR (95%CI)	aOR (95%CI)
Age
<70 yr	1	1
≥70 yr	1.50 (1.19, 1.88)	1.10 (0.83, 1.47)
Sex
Male	1	1
Female	1.31 (1.08, 1.58)	1.19 (0.97, 1.45)
Type of admission
Elective	1	1
Emergency	1.90 (1.45, 2.50)	1.42 (1.07, 1.87)
Insurance status
Medicare/Medicaid	1	1
Private including HMO	0.65 (0.53, 0.80)	0.78 (0.60, 1.01)
Self-pay/no charge/other	0.49 (0.29, 0.85)	0.56 (0.31, 1.00)
Primary tumor site
Colon	1	1
Rectum	0.67 (0.52, 0.87)	0.86 (0.66, 1.14)
Extent of liver resection
Partial hepatectomy	1	1
Hepatic lobectomy	1.54 (1.24, 1.91)	1.76 (1.42, 2.19)
Comorbidity
Chronic anemia	2.98 (2.34, 3.80)	2.62 (2.04, 3.35)
Congestive heart failure	2.20 (1.32, 3.69)	1.57 (0.91, 2.68)
Hypertension	1.27 (1.03, 1.57)	1.10 (0.88, 1.37)
Bed size of hospital
Small	1	1
Medium	1.43 (1.00, 2.04)	1.26 (0.85, 1.86)
Large	0.95 (0.69, 1.30)	0.92 (0.65, 1.30)
Teaching status of hospital
Non-teaching	1	1
Teaching	0.59 (0.46, 0.76)	0.75 (0.58, 0.98)

OR: Odds ratio; aOR: Adjusted OR; CI: Confidence interval. Numbers in bold indicate statistical significance (P < 0.05).

Table 3 Characteristics of patients stratified by postoperative complications

	Total	No transfusion	Perioperative transfusion
	n = 2018	n = 1538	n = 480
Overall postoperative complications	338 (16.67)	229 (11.31)	109 (5.36)
Infection	108 (5.36)	67 (3.31)	41 (2.05)
Intra-abdominal abscess	45 (2.19)	27 (1.30)	18 (0.89)
Infected post-operative seroma	5 (0.26)	4 (0.22)	1 (0.05)
Wound dehiscence	27 (1.31)	21 (1.02)	6 (0.29)
UTI	32 (1.59)	26 (1.29)	6 (0.30)
Pulmonary complications	41 (2.05)	21 (1.04)	20 (1.00)
DVT	26 (1.29)	18 (0.90)	8 (0.39)
Postoperative myocardial infarction	58 (2.88)	42 (2.10)	16 (0.78)
Sepsis	30 (1.44)	23 (1.09)	7 (0.34)
Ascites	65 (3.20)	43 (2.13)	22 (1.07)
Acute liver failure	14 (0.70)	10 (0.49)	4 (0.21)
Other digestive system complications	17 (0.81)	14 (0.67)	3 (0.14)

Data are presented as unweighted counts (weighted proportion). Percentages may not add up to 100% due to missing data. DVT: Deep vein thrombosis; UTI: Urinary tract infection.

Table 4 Associations between perioperative transfusion and length of hospital stay, in-hospital mortality, and postoperative complications

	Univariate	Multivariate
Linear regression	Β ± SE	Β ± SE
Length of stay	2.01 ± 0.37	1.51 ± 0.361
Logistic regression	OR (95%CI)	aOR (95%CI)
In-hospital mortality	4.42 (2.05, 9.51)	3.38 (1.57, 7.25)2
Overall postoperative complications	1.69 (1.33, 2.15)	1.67 (1.31, 2.13)3

¹Multivariate analysis was adjusted for sex, type of admission, chronic anemia, congestive heart failure, hypertension, and bed size of hospital;

²Multivariate analysis was adjusted for age, type of admission, extent of liver resection, and hypertension;

³Multivariate analysis was adjusted for congestive heart failure and hypertension. β: Estimate; SE: Standard error; OR: Odds ratio; aOR: Adjusted OR; CI: Confidence interval. Numbers in bold indicate statistical significance (P < 0.05).