Improved postoperative outcomes and reduced transfusion rates after implementation of a Patient Blood Management program in gastric cancer surgery. Issue 6 (June 2021)

• Record Type: Journal Article
• Authors: Osorio, Javier; Jericó, Carlos; Miranda, Coro; Santamaría, Maite; Artigau, Eva; Galofré, Gonzalo; Garsot, Elisenda; Luna, Alexis; Puértolas, Noelia; Aldeano, Aurora; Olona, Carles; Molinas, Joan; Feliu, Josep; Videla, Sebastián; Tebe, Cristian; Pera, Manuel
• Is Part Of: European journal of surgical oncology. Volume 47:Issue 6(2021)
• Page Start: 1449
• Page End: 1457
• Publication Date: 2021-06
• Subjects: Gastric cancer -- Patient blood management -- Blood transfusion -- Surgery -- Anemia -- Preoperative optimization; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2020.11.129
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Introduction: Gastric cancer patients are often transfused with red blood cells, with negative impact on postoperative course. This multicenter prospective interventional cohort study aimed to determine whether implementation of a Patient Blood Management (PBM) program, was associated with a decrease in transfusion rate and improvements in clinical outcomes in gastric cancer surgery. Methods: We compared transfusion practices and clinical outcomes in patients undergoing elective gastric cancer resection before and after implementing a PBM program, including strategies to detect and treat anemia and restrictive transfusion practice (2014–2018). Primary outcome was transfusion rate (TR). Secondary outcomes were complications, reoperations, length of stay, readmissions, 90-day mortality and failure-to-rescue. Differences were adjusted by confounding factors. Results: Some 789 patients were included (496 pre- and 293 post-PBM). TR decreased from 39.1% to 27.0% (adjusted difference −9.1, 95% CI -15.2 to −2.9), being reduction particularly significant in patients with anemia, ASA score 3–4, locally advanced tumors, undergoing open surgery and total gastrectomy. Infectious complications diminished from 25% to 16.4% (−6.1, 95%CI -11.5 to −0.7), reoperations from 8.1% to 6.1% (−2.2, 95%CI -5.1 to +0.6), median length of stay from 11 [IQR 8–18] to 8 [7–12] days (p < 0.001), hospital readmission from 14.1% to 8.9% (−5.4, 95%CI -9.6 to −1.1), mortality from 7.9% to 4.8% (−2.4, 95%CI -4.7 to −0.01), and failure-to rescue from 62.7% to 32.7% (−23.1, 95%CI -37.7 to −8.5). Conclusion: Implementation of a PBM program was associated with a reduction in transfusion rate and improvement in postoperative outcomes in gastric cancer patients undergoing curative resection.