Abstract 12: Perioperative blood transfusion in gynecologic surgery
Lauren S. PrescottThomas A. AloiaAlaina J. BrownJolyn TaylorCharlotte C. SunCharles LevenbackKathleen M. SchmelerDiane C. Bodurka
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Objective To study the relationship between perioperative transfusion and postoperative infection.Methods 567 cases of perioperative transfusion from 1992 to 2007 were analysed.According to the blood components it was divided into whole blood transfusion group,frozen plasma group,and concentrated red cell group.The relation of the blood category and quantities with postoperative infection was analysed.The results were compared with non-transfusion group of 856 cases.Results The postoperative infection rate of whole blood transfusion group was 12.4%,the infection rate of frozen plasma transfusion was 7.3%,and that of red cell transfusion was 5.6%.There was significant difference among them(P0.05).Conclusion There is a close correlation between perioperative transfusion and postoperative infection.The infection rate by whole blood or plasma transfusion is high and by component transfusion is comparatively low.
Fresh frozen plasma
Infection rate
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Objective To investigate the relationship between perioperative blood transfusion and postoperative wound infection in patients with oral squamous cell carcinoma(OSCC). Methods 753 patients with OSCC in T2 stage were retrospectively analysed. Results Postoperative wound infection rates of patients with perioperative blood transfusion and patients without perioperative blood transfusion were 8.4% and 3.9%,respectively,and there was a significant statistical difference between the two groups (P0.05). Postoperative wound infection rate was increased with the amount of blood transfusion. Conclusion Postoperative wound infection rate of patients with perioperative blood transfusion is significantly higher than that of patients without perioperative blood transfusion. Perioperative blood transfusion should be applied properly.
Wound infection
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Objective: To study the effects of allogeneic blood transfusion on polarized Th cell in gastric carcinoma patients during perioperative time. Methods: Thirty patients undergoing gastric carcinectomy were randomly divided into three groups with 10 patients in each group: group A received no allogeneic blood; group B received leukodepleted blood; group C received allogeneic whole blood during perioperative time. The polarized rates of Th cell were measured by flow cytometry. Results: The counts of Th1 in group A decreased significantly on the 2nd postoperation, but returned to the baseline levels on the 5th postoperative day. The Th1 counts and Th1/Th2 ratio decreased significantly in group B and group C after blood transfusion(P0.05). The Th2 counts increased significantly in group B and C postoperative time. On the 10th postoperative day the Th1?Th2 cell counts and Th1/Th2 ratio returned to preoperative level in group B, but remained low in group C. As compared with that in group A, the Th1 cell counts, Th1/Th2 ratio reduced and Th2 cell counts increased markedly in group C than in group B(P0.05). Conclusion: Perioperative blood transfusion contributes to the immunosuppression, which is more serious after whole blood transfusion than leukodepleted blood. In perioperative period component blood transfusion is superior to whole blood transfusion. The Th cells polarized to Th2 cells may be one of the causes of immunosuppression in patients received allogeneic blood transfusion.
Immunosuppression
Group B
Group A
Blood cell
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This study retrospectively evaluated the association between perioperative blood transfusion and intrahepatic recurrence in patients with hepatocellular carcinoma (HCC) who had undergone curative hepatic resections.Hepatic resection was performed with curative intent in 195 patients with primary HCC between 1985 and 1996. Patients who had received perioperative blood transfusion (transfused group: n = 117) and those who had no perioperative blood transfusion (nontransfused group: n = 78) were compared in terms of conventional prognostic variables and cancer-free survival by the univariate and multivariate analyses.The 1-, 3-, and 5-yr cancer-free survival rates in the nontransfused and transfused groups were 83.4% and 67.9%, 43.0% and 36.7%, and 23.1% and 24.6%, respectively (p = 0.175). Multivariate analysis of prognostic factors in all patients revealed that vascular invasion, tumor size (> or =5 cm), and Child's class were independent factors for intrahepatic recurrence. Further analyses in various stratified groups showed that perioperative blood transfusion was an independent predictor of prognosis in HCC patients with portal vein invasion (RR: 2.8, p = 0.0038). The 1-, 3-, and 5-yr survival rates in the nontransfused and transfused groups with portal vein invasion were 71.9% and 41.6%, 54.5% and 10.9%, and 26% and 0%, respectively (p = 0.0003).We conclude that perioperative blood transfusions enhance the risk of intrahepatic recurrence of HCC in patients with portal vein invasion. As well, the more difficult surgery and the increased manipulation of the liver that occur in these cases create a greater possibility of tumor dissemination.
Univariate analysis
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The association between perioperative blood transfusion and the prognosis of patients with gastric cancer is still unclear.A total of 1581 patients with gastric cancer who underwent curative gastrectomy from 2000 to 2008 were evaluated. Perioperative blood transfusion was defined as the transfusion of packed red blood cells within seven days before surgery, during surgery, or within the postoperative hospitalization period. The association between perioperative blood transfusion and prognosis was evaluated using univariate and multivariate Cox regression analyses.Of 1581 patients, 298 patients (19%) received perioperative blood transfusion. Perioperative blood transfusion correlated with older age (P < 0.001); larger tumor size (P < 0.001); and more advanced stage (P < 0.001). Five-year survival rate was 40% in patients who had perioperative blood transfusion and 55% patients who did not have perioperative blood transfusion, and the difference was statistically significant (P < 0.001). Multivariate analysis showed that perioperative blood transfusion was defined as independent prognostic factor. Perioperative blood transfusion was associated with worse outcomes in patients with stage III (P < 0.001).Perioperative blood transfusion independently correlated with poorer prognosis in patients with gastric cancer.
Surgical oncology
Univariate analysis
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[Objective]To analyze the perioperative blood loss after surgery for elderly patients in intertrochanteric fractures and the relative factors to provide the data for clinical treatment in perioperative period.[Method]The clinical data of 38 cases of intertrochanteric fracture patients treated with DHS and 55 cases of intertrochanteric fracture patients treated with PFNA from October 2009 to October 2012 were retrospectively analyzed.All the cases were fresh intertrochanteric fracture following primary operation.According to Gross formulae,we calculated the total blood loss with the patients' height,weight,Hct,to evaluate the perioperative blood loss after Surgery.[Result]The mean hidden blood loss were 468 ml in DHS group,about 80.6% of the total blood loss volume.In PFNA group,the number was 554 ml and 89.4%.Hidden blood loss was the major part of the perioperative blood loss in intertrochanteric fracture.The blood loss was relative with the gender,age,height,weight,fracture type.There was significant difference in the blood loss between DHS group and PFNA group.[Conclusion]Much attention should be paid to the relative factors and the vital signs of the patients in the perioperative period,to supplement the blood volume during perioperative period after surgery in time to prevent the complications.
Intertrochanteric fracture
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Objective To discuss the safety and effect of transfusion plan guided by Peri- operative transfusion trigger score( POTTS) in perioperative patients. Methods 84 perioperative patients were randomly divided in to the observation group( n = 42) and the control group( n = 42),the transfusion plan of the observation group were guided by POTTS,and the control group was guided by Journal of Clinical Transfusion technical specification( 2000),then the perioperative blood transfusion rate,amount of blood transfusion,complications,mortality,blood transfusion costs,hospital stay,postoperative drainage,postoperative suture removal time were contrasted between the two groups. Results The perioperative blood transfusion rate and amount of blood transfusion were significantly lower in the observation group than the control group( P 0. 01),there was no severe complication and death in the two groups; blood transfusion costs in the observation group was significantly lower than the control group( P 0. 01),hospital stay and postoperative suture removal time were significantly less than the control group( P 0. 01),but no significantly difference in postoperative drainage( P 0. 05).Conclusions POTTS is safe and effective in guidance of transfusion plan in perioperative patients,it can avoid unnecessary blood transfusions,save blood resource,reduce blood transfusion costs,shorten hospital stay,and is worthy of promotion.
Blood product
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Abstract Purpose : The purpose is to identify risk factors for perioperative blood transfusion in patients undergoing hysterectomy for benign disease. Methods : This study is a retrospective chart review including all the patients who underwent hysterectomy for benign disease between January 1 st 2018 and December 31 st 2019. Patients who received perioperative blood transfusion were identified and compared to those who did not. The following risk factors for blood transfusion were analyzed: route of hysterectomy, BMI, presence of adhesions, history of cesarean section, uterine weight. Descriptive statistics was used to analyze the data. Results : A total of 517 patients were identified and included in the study. Forty-seven patients (9.09 %) received a perioperative blood transfusion. The abdominal hysterectomy route (TAH) was a significant risk factor for receiving blood transfusion (p=0.012). Other identified risk factors for blood transfusion included: Body mass index above 33.0 (p=0.002), and uterine weight (p=0.002). There was no association between the presence of pelvic adhesions (p=0.91) or a personal history of cesarean section (p=0.89) and receiving perioperative blood transfusion. When analyzing only the patients who underwent TLH, the presence of pelvic adhesion was found as a risk factor for perioperative blood transfusion (p=0.024) Conclusion : The abdominal hysterectomy route, the presence of a large uterus, and obesity are risk factors for receiving a blood transfusion. Early identification of the patient at risk of requiring perioperative blood transfusion provides better patient counseling and surgical preparation.
Abdominal hysterectomy
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The decision to perform intraoperative blood transfusion is subject to a variety of clinical and laboratory factors. This study examined variation in haemoglobin (Hb) triggers and overall utilization of intraoperative blood transfusion, as well the impact of transfusion on perioperative outcomes.The study included all patients who underwent pancreatic, hepatic or colorectal resection between 2010 and 2013 at Johns Hopkins Hospital, Baltimore, Maryland. Data on Hb levels that triggered an intraoperative or postoperative transfusion and overall perioperative blood utilization were obtained and analysed.Intraoperative transfusion was employed in 437 (15·6 per cent) of the 2806 patients identified. Older patients (odds ratio (OR) 1·68), patients with multiple co-morbidities (Charlson co-morbidity score 4 or above; OR 1·66) and those with a lower preoperative Hb level (OR 4·95) were at increased risk of intraoperative blood transfusion (all P < 0·001). The Hb level employed to trigger transfusion varied by sex, race and service (all P < 0·001). A total of 105 patients (24·0 per cent of patients transfused) had an intraoperative transfusion with a liberal Hb trigger (10 g/dl or more); the majority of these patients (78; 74·3 per cent) did not require any additional postoperative transfusion. Patients who received an intraoperative transfusion were at greater risk of perioperative complications (OR 1·55; P = 0·002), although patients transfused with a restrictive Hb trigger (less than 10 g/dl) showed no increased risk of perioperative morbidity compared with those transfused with a liberal Hb trigger (OR 1·22; P = 0·514).Use of perioperative blood transfusion varies among surgeons and type of operation. Nearly one in four patients received a blood transfusion with a liberal intraoperative transfusion Hb trigger of 10 g/dl or more. Intraoperative blood transfusion was associated with higher risk of perioperative morbidity.
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