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Is there an optimal trade‐off between anaemia and red blood cell transfusion in surgical critically ill patients after oncologic surgery?
Author(s) -
Chapalain Xavier,
Ozier Yves,
Le Niger Catherine,
McQuilten Zoe,
Huet Olivier,
Aubron Cécile
Publication year - 2021
Publication title -
vox sanguinis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.68
H-Index - 83
eISSN - 1423-0410
pISSN - 0042-9007
DOI - 10.1111/vox.13068
Subject(s) - medicine , blood transfusion , surgery , intensive care unit , complication , retrospective cohort study , abdominal surgery , acute kidney injury
Background and objectives Equipoise remains on the optimal transfusion strategy in surgical oncologic patients. The primary objective of our study was to determine the impact of anaemia and red blood cells (RBCs) transfusion on severe postoperative complications in surgical oncologic critically ill patients. Materials and methods Retrospective single‐centre study. Adults admitted to intensive care unit after major oncologic surgery were eligible. Analyses to determine the independent risk factors, including anaemia or RBC transfusion, for postoperative complications and/or hospital mortality were performed. Results Of the 283 patients included, 246 patients (86.9%) had anaemia. Fifty‐five patients (19·4%) were transfused. Patients exposed to moderate‐to‐severe anaemia or RBC transfusion had more often severe complications, especially acute kidney injury and infectious complications. Multivariate analysis found an independent association between moderate and severe anaemia and severe postoperative complications (moderate anaemia: OR 14·02 [2·52–264]; severe anaemia: OR 16·25 [2·62–318·5]; P < 0·05). Elderly, obese patients and patients operated from abdominal surgery appeared to be more vulnerable to anaemia than other patients. Transfusion was also an independent risk factor for postoperative complications (OR 4·19 [2·12–8·39]; P < 0·001). When considering moderate‐to‐severe anaemic patients, RBC transfusion was no longer associated with postoperative complications. Conclusions Anaemia was associated with severe postoperative complications, and this association was stronger in elderly, obese patients and after abdominal surgery. RBC transfusion also negatively impacts on patients’ prognosis. However, this association was not found in case of moderate‐to‐severe anaemia exposure (haemoglobin < 10 g/dl).