Improved postoperative outcomes and reduced transfusion rates after implementation of a Patient Blood Management program in gastric cancer surgery.
Anemia
/ blood
Blood Transfusion
/ statistics & numerical data
Elective Surgical Procedures
Failure to Rescue, Health Care
Female
Gastrectomy
/ adverse effects
Hemoglobins
/ metabolism
Humans
Length of Stay
/ statistics & numerical data
Male
Patient Readmission
/ statistics & numerical data
Postoperative Complications
/ etiology
Preoperative Care
Prospective Studies
Reoperation
/ statistics & numerical data
Stomach Neoplasms
/ complications
Survival Rate
Anemia
Blood transfusion
Gastric cancer
Patient blood management
Preoperative optimization
Surgery
Journal
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
ISSN: 1532-2157
Titre abrégé: Eur J Surg Oncol
Pays: England
ID NLM: 8504356
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
received:
25
09
2020
revised:
06
11
2020
accepted:
20
11
2020
pubmed:
4
12
2020
medline:
12
10
2021
entrez:
3
12
2020
Statut:
ppublish
Résumé
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. 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. 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). 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.
Identifiants
pubmed: 33267997
pii: S0748-7983(20)31025-8
doi: 10.1016/j.ejso.2020.11.129
pii:
doi:
Substances chimiques
Hemoglobins
0
Types de publication
Comparative Study
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1449-1457Informations de copyright
Copyright © 2020 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest Javier Osorio has received honoraria for lectures from Vifor Pharma España SL, but not for this work. Carlos Jericó has received honoraria for lectures/consultancies from Vifor Pharma España SL, Bial and Zambon, but not for this work. For the remaining authors, there are no conflicts of interest to be declared.