Abstract
Background
Blood transfusion is associated with higher postoperative complication. With the availability of autologous blood and erythropoietin, it would be advantageous to identify patients who are at higher risk for requiring blood transfusion. Our aim is to identify possible predictive factors for perioperative blood transfusion in patients undergoing colorectal resection. We examined 206 patients who underwent colorectal resections.
Materials and methods
We analyzed factors including preoperative hematocrit, age, history of radiation, type of resection, operative blood loss, additional surgical procedure, surgery duration, and comorbidity.
Results
Forty-one patients (19.9%) received perioperative blood transfusion. Twenty patients (55.6%) with preoperative hematocrit less than 30 received transfusion (p < 0.0001). Twenty-one patients (12.4%) with preoperative hematocrit greater than 30 received perioperative blood transfusion. Thirty-three patients (17.9%) under 65 years received transfusion. Eight patients (36.4%) more than the age of 65 received transfusion (p = 0.05). Ten patients (16.1%) without any comorbidity received transfusion, whereas ten patients (15.1%) with one comorbidity, ten patients (22.2%) with two comorbidities, and 11 patients (33.3%) with greater than three comorbidities received blood transfusion (p = 0.07). In the multivariate analysis, relative risk of perioperative blood transfusion was 3.63 for patients with preoperative hematocrit less than 30 (p < 0.0001), 1.26 for patients more than the age of 65 (p = 0.49), and 1.07 for each comorbidity (p = 0.62). Patients with higher number of comorbidities and age greater than 65 tend to have lower preoperative hematocrit than other patients.
Conclusion
Hematocrit less than 30 is an independent risk factor for requiring perioperative blood transfusion, and patients with hematocrit less than 30 should be considered for autologous blood transfusion and erythropoietin.
Similar content being viewed by others
References
Dzik S, Blajchman MA, Blumberg N et al (1996) Current research on the immunomodulatory effect of allogeneic blood transfusion. Vox Sang 70:187–194
Fransen E, Maessen J, Senden N et al (1999) Impact of blood transfusions on inflammatory mediator release in patients undergoing cardiac surgery. Chest 116:1233–1239
Zallen G, Moore EE, Ciesla DJ et al (2000) Stored red blood cells selectively activate human neutrophils to release IL-8 and secretory PLA-2. Shock 13:29–33
Haynes SL, Wong JC, Torella F, Dalrymple K, Pilsworth L, McCollum CN (2001) The influence of homologous blood transfusion on immunity and clinical outcome in aortic surgery. Eur J Vasc Endovasc Surg 22:244–250
Innerhofer P, Luz G, Spotl L et al (1999) Immunologic changes after transfusion of buffy coat-poor versus white cell-reduced blood to patients undergoing arthroplasty. Transfusion 39:1089–1096
Malone DL, Dunne J, Tracy JK, Putnam AT, Scalea TM, Napolitano LM (2003) Blood transfusion, independent of shock severity, is associated with worse outcome in trauma. J Trauma 54:898–907
Moore FA, Moore EE, Sauaia A (1997) Blood transfusion. An independent risk factor for postinjury multiple organ failure. Arch Surg 132:620–625
Tang R, Chen HH, Wang YL, Changchien CR, Chen JS, Hsu KC, Chiang JM, Wang JY (2001) Risk factors for surgical site infection after elective resection of the colon and rectum: a single-center prospective study of 2809 consecutive patients. Ann Surg 234(2):181–189
Mynster T, Christensen IJ, Moesgaard F, Nielsen HJ (2000) Effects of the combination of blood transfusion and postoperative infectious complications on prognosis after surgery for colorectal cancer. Br J Surg 87:1553–1562
Tartter PI (1998) Blood transfusion and infectious complications following colorectal cancer surgery. Br J Surg 75:789–792
Donohue JH, Williams S, Cha S, Windschitl HE, Witzig TE, Nelson H, Fitzgibbons RJ, Wieand HS, Moertel CG (1995) Perioperative blood transfusions do not affect disease recurrence of patients undergoing curative resection of colorectal carcinoma: A Mayo/North Central Cancer Treatment Group Study. J Clin Oncol 13:1671–1678
Heiss MM, Mempel W, Delanoff C, Jauch KW, Gabka C, Mempel M, Dieterich HJ, Eissner HJ, Schildberg FW (1994) Blood transfusion-modulated tumor recurrence: first results of a randomized study of autologous versus allogeneic blood transfusion in colorectal cancer surgery. J Clin Oncol 12:1859–1867
Amato A, Pescatori M (1998) Effect of perioperative blood transfusions on recurrence of colorectal cancer. Meta-analysis stratified on risk factors. Dis Colon Rectum 41:570–585
Kumar R, Chakraborty I, Sehgal R (2002) A prospective randomized study comparing two techniques of perioperative blood conservation: isovolemic hemodilution and hypervolemic hemodilution. Anesth Analg 95(5):1154–1161
Gohel MS, BulBulia RA, Slim FJ, Poskitt KR, Whyman MR (2005) How to approach major surgery where patients refuse blood transfusion (including Jehovah’s witnesses). Ann R Coll Surg Engl 87(1):3–14
Karkouti K, McCluskey SA, Evans L, Mahomed N, Ghannam M, Davey R (2005) Erythropoietin is an effective clinical modality for reducing RBC transfusion in joint surgery. Can J Anaesth 52(4):362–368
Garcia-Erce JA, Cuenca J, Munoz M, Izuel M, Martinez AA, Herrera A, Salano VM, Martinez F (2005) Perioperative stimulation of erythropoiesis with intravenous iron and erythropoietin reduces transfusion requirements in patients with hip fracture. A randomized observational study. Vox Sang 88(4):235–243
Kosmadakis N, Messaris E, Maris A, Katsaragakis S, Leandros E, Konstadoulakis MM, Androulakis G (2003) Perioperative erythropoietin administration in patients with gastrointestinal tract cancer: prospective randomized double-blind study. Ann Surg 237(3):417–421
Opelz G, Henneman IPH, Ruigrok M et al (1978) Improvement of kidney-graft survival with increased numbers of blood transfusion. N Engl J Med 299:799–803
Taylor RW, Manganaro L, O’Brien J, Trottier SJ, Parkar N, Veremakis C (2002) Impact of allogenic packed red blood cell transfusion in nosocomial infection rates in the critically ill patients. Crit Care Med 30:2249–2254
Tartter PI, Mohandas K, Azar P, Endres J, Kaplan J, Spivack M (1998) Randomized trial comparing packed red cell blood transfusion with and without leukocyte depletion for gastrointestinal surgery. Am J Surg 176:462–466
Benoist S, Panis Y, Pannegeon V, Alves A, Valleur P (2001) Predictive factors for perioperative blood transfusions in rectal resection for cancer: a multivariate analysis of a group of 212 patients. Surgery 129:433–439
Malone D, Kuhls D, Napolitano LM, McCarter R, Scalea T (2000) Blood transfusion in the first 24 hours in associated with systemic inflammatory response syndrome (SIRS) and worse outcome in trauma. Crit Care Med 28(Suppl):A138
Kettelhack C, Hones C, Messinger D, Schlag PM (1998) Randomized. multicentre trial of the recombinant human erythropoitin on intraoperative and postoperative transfusion need in anemic patients undergoing right hemicolectomy for carcinoma. Br J Surg 85(1):63–67
de Andrade JR, Jove M, Landon G, Frei D, Guilfoyle M, Young DC (1996) Baseline hemoglobin as a predictor of risk of transfusion and response to Epoetin alfa in orthopedic surgery patients. Am J Orthop 25(8):533–542
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kim, J., Konyalian, V., Huynh, R. et al. Identification of predictive factors for perioperative blood transfusion in colorectal resection patients. Int J Colorectal Dis 22, 1493–1497 (2007). https://doi.org/10.1007/s00384-007-0347-2
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-007-0347-2