Long-term outcomes of an integrated transfusion reduction initiative in patients undergoing resection for colorectal cancer

• Published in: The American journal of surgery 2015-12, Vol.210 (6), p.990-995
• Main Authors: Van Osdol, Andrew D., M.D, Borgert, Andrew J., Ph.D, Kallies, Kara J., M.S, Froman, Joshua P., M.D, Bottner, Wayne A., M.D, Shapiro, Stephen B., M.D., F.A.C.S
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Aged; Blood transfusion; Blood Transfusion - statistics & numerical data; Cancer recurrence; Cancer therapies; Colorectal cancer; Colorectal Neoplasms - mortality; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Colorectal surgery; Decision making; Documentation; Education; Female; Hematology; Hospitals; Humans; Laboratories; Length of Stay - statistics & numerical data; Male; Medical records; Morbidity; Mortality; Neoplasm Recurrence, Local; Neoplasm Staging; Perioperative morbidity and mortality; Retrospective Studies; Surgery; Survival; Survival analysis; Survival Rate; Treatment Outcome
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2015.06.026

Abstract Background Perioperative blood transfusion in patients with colorectal cancer has been associated with increased cost, morbidity, mortality, and decreased survival. Five years ago, a transfusion reduction initiative (TRI) was implemented. We sought to evaluate the 5-year effectiveness and patient outcomes before and after the TRI. Methods Patients who underwent colorectal resection for adenocarcinomas before (January 2006 to October 2009) and after the TRI (November 2009 to December 2013) were reviewed. Results A total of 484 patients were included; 267 and 217 patients were in the pre- and post-TRI groups, respectively. Decreased overall transfusion rates were sustained throughout the entire post-TRI era (17% vs 28%, P = .006). Three-year colorectal cancer disease-free survival rates were similar in the pre- and post-TRI eras at 85.3% (95% confidence interval [CI]: 79.9 to 89.3) and 81.6% (95% CI: 71.9 to 88.2), respectively. Three-year disease-free survival rate was lower in those receiving BTs vs those without BTs at 78.4% (95% CI: 65.7 to 86.8) vs 85.3% (95% CI: 80.4 to 89.1), respectively. Conclusions A TRI remains a safe, effective way to reduce blood utilization in colorectal cancer surgery.