The Association Between Perioperative Red Blood Cell Transfusions and 1-Year Mortality After Major Cancer Surgery: An International Multicenter Observational Study.

Autor:	Cata JP; From the Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.; Anesthesiology and Surgical Oncology Research Group, Houston, Texas., Guerra-Londono JJ; From the Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.; Anesthesiology and Surgical Oncology Research Group, Houston, Texas., Ramirez MF; From the Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas., Chen LL; Department of Anesthesia and Perioperative Care, University of California-San Francisco, San Francisco, California., Warner MA; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota., Guzman LFC; Department of Anesthesiology and Critical Care, Instituto Nacional de Cancerología de México, Mexico City, Mexico., Lobo F; Department of Anesthesiology, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates., Uribe-Marquez S; Department of Anesthesiology, Henry Ford Health, Detroit, Michigan., Huang J; Department of Anesthesiology, H. Lee Moffitt Cancer Center, Tampa, Florida., Ruscic KJ; Department of Anesthesia, Critical Care and Pain Medicine, The Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts., Chew STH; Department of Anesthesiology and Perioperative Sciences, Singapore General Hospital-Duke-NUS Medical School, Singapore, Singapore., Lanigan M; Department of Anesthesiology, University of Minnesota, Minneapolis, Minnesota.
Jazyk:	angličtina
Zdroj:	Anesthesia and analgesia [Anesth Analg] 2024 Nov 06. Date of Electronic Publication: 2024 Nov 06.
DOI:	10.1213/ANE.0000000000007236
Abstrakt:	Background: Packed red blood cell (pRBC) transfusions in patients undergoing surgery for cancer are given to treat anemia or acute hemorrhage. Evidence indicates that pRBC transfusions are associated with poor perioperative and oncological outcomes. The ARCA-1 (Perioperative Care in the Cancer Patient-1) study was designed to test the association between perioperative pRBC transfusions and postoperative morbidity and mortality in patients undergoing cancer surgery. The primary hypothesis of our study was that perioperative pRBC transfusions have a negative impact on postoperative morbidity and 1-year mortality. Methods: ARCA-1 was an international multicenter prospective observational cohort study. Participating centers enrolled a minimum of 30 consecutive adult patients with cancer who underwent surgery with curative intent. The primary end point was all-cause mortality 1 year after major cancer surgery. Secondary end points were rates of perioperative blood product use, 1-year cancer-specific mortality, overall survival, and 30-day morbidity and mortality. We performed a propensity score matching analysis to adjust for selection bias. A multivariable logistic regression model was fitted to estimate the effects of significant covariates on 1-year mortality, cancer-related mortality, and overall survival. Results: A total of 1079 patients were included in the study. The rate of perioperative pRBC transfusions was 21.1%. Preoperative comorbidities, including anemia, American Society of Anesthesiologists (ASA) score of III to IV, a history of coronavirus disease 2019 (COVID-19), myocardial infarction, stroke, need for dialysis, history of blood transfusions, and metastatic disease were statistically significantly more frequent in transfused patients compared to nontransfused patients. The 1-year mortality rate was higher in transfused patients before (19.7% vs 6.5%; P < .0001) and after (17.4% vs 13.2%; P = .29) propensity score matching. 1-year mortality was 1.97 times higher in transfused than in no-transfused patients (odd ratio [OR], 1.97; 95% confidence interval [CI], 1.13-3.41). The odds of 1-year cancer mortality for patients who had perioperative pRBCs was 1.82 times higher (OR, 1.82; 95% CI, 0.97-3.43) compared to those who did not receive perioperative pRBC transfusion. The effect of perioperative pRBC transfusion on overall survival was also significant (hazard ratio [HR], 1.85; 95% CI, 1.15-2.99). Transfused patients also had a higher rate of 30-day postoperative mortality before (3.5% vs 0.7%; P = .0009) and after propensity score matching (4.2% vs 1.8%; P = .34). Conclusions: This international, multicenter observational study showed that perioperative pRBC transfusion was associated with an increased mortality risk. Competing Interests: Conflicts of Interest, Funding: Please see DISCLOSURES at the end of this article. (Copyright © 2024 International Anesthesia Research Society.)
Databáze:	MEDLINE
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