Perioperative Transfusion Management in Gastric Cancer Surgery: Analysis of the Spanish Subset of the EURECCA Oesophago-Gastric Cancer Registry

• Published in: Cirugia española (English ed.) 2018-11, Vol.96 (9), p.546-554
• Main Authors: Osorio, Javier, Jericó, Carlos, Miranda, Coro, Garsot, Elisenda, Luna, Alexis, Miró, Mónica, Santamaría, Maite, Artigau, Eva, Rodríguez-Santiago, Joaquín, Castro, Sandra, Feliu, Josep, Aldeano, Aurora, Olona, Carles, Momblan, Dulce, Ruiz, David, Galofré, Gonzalo, Pros, Inmaculada, García-Albéniz, Xabier, Lozano, Miguel, Pera, Manuel
• Format: Article
• Language: English
• Subjects: Blood transfusion; Cirugía; Cáncer gástrico; Gastric cancer; Hierro intravenoso; Intravenous iron; Surgery; Transfusión sanguínea
• ISSN: 2173-5077; 2173-5077
• DOI: 10.1016/j.cireng.2018.10.016

This study evaluated allogenic packed red blood cell (aPRBC) transfusion rates in patients undergoing resection for gastric cancer and the implementation of blood-saving protocols (BSP). Retrospective study of all gastric cancer patients operated on with curative intent in Catalonia and Navarra (2011–2013) and included in the Spanish subset of the EURECCA Oesophago-Gastric Cancer Registry. Hospitals with BSP were defined as those with a preoperative haemoglobin (Hb) optimization circuit associated with restrictive transfusion strategies. Predictors of aPRBC transfusion were identified by multinomial logistic regression analysis. A total of 652 patients were included, 274 (42.0%) of which received aPRBC transfusion. Six of the 19 participating hospitals had BSP and treated 145 (22.2%) patients. Low Hb level at diagnosis (10 vs 12.4g/dL), ASA score III/IV, pT3-4, open surgery, associated visceral resection, and having being operated on in a hospital without BSP were predictors of aPRBC transfusion, while low Hb level, associated visceral resection, and non-BSP hospital remained predictors in the multivariate analysis. In case of comparable risk factors for aPRBC transfusion, there was a higher use of preoperative intravenous iron treatment (26.2% vs 13.2%) and a lower percentage of transfusions (31.7% vs 45%) in hospitals with BSP. The perioperative transfusion rate in gastric cancer was 42%. Hospitals with BSP showed a significant reduction of blood transfusions but treated only 22% of patients. Main predictors of aPRBC were low Hb level, associated visceral resection, and undergoing surgery at a hospital without BSP. Este estudio evaluó la tasa de transfusión de concentrados de hematíes alogénicos (TCHA) en la cirugía de resección del cáncer gástrico y la difusión de los protocolos de ahorro transfusional (PAT). Estudio retrospectivo de todos los pacientes operados por adenocarcinoma gástrico con intención curativa en Cataluña y Navarra (2011–2013) e incluidos en el registro del grupo español EURECCA de cáncer esófago-gástrico. Los hospitales con PAT disponían de un circuito de optimización preoperatoria de la hemoglobina (Hb) y de política transfusional restrictiva. Los factores predictores de TCHA se identificaron mediante una regresión logística multinomial. Se incluyeron 652 pacientes, 274 (42%) de los cuales recibieron TCHA. Seis de los 19 hospitales disponían de PAT (22% de los pacientes). La Hb baja al diagnóstico (10 vs 12,4g/dL), una puntuación AS