Peri-op transfusion raises short-term morbidity risk

Perioperative blood transfusion for patients undergoing radical prostatectomy is associated with increased short-term morbidity, according to a recent study presented at the AUA annual meeting in San Diego. 

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“Blood transfusion in the perioperative period, either immediately after surgery or during surgery, has been associated with worse overall survival for several malignancies, including prostate cancer. It has been suggested that the allogeneic blood stimulates an inflammatory response that may promote tumor growth. Keeping this in mind, we hypothesized that the use of perioperative blood transfusion during radical prostatectomy may be associated with increased short-term morbidity,” explained first author Justin T. Matulay, MD, of Columbia University Medical Center, New York.  

Dr. Matulay presented findings from a retrospective analysis of 30-day postoperative outcomes in men undergoing radical prostatectomy from 2005 to 2013 using the National Surgical Quality Improvement (NSQIP) database. The primary outcome was 30-day postoperative morbidity, and secondary outcomes were 30-day mortality, readmission, length of stay, infectious complications, and pulmonary complications.

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The authors found that of the 21,293 radical prostatectomies performed during the period covered, 810 patients (3.9%) received a perioperative blood transfusion. Perioperative blood transfusion was associated with increased 30-day morbidity, readmission, pulmonary complications, and surgical site infections, they reported.

Next: What surprised the authors

Transfusion was more common in patients with higher body mass index, lower functional status, and longer operative times. When controlling for comorbidities, having a blood transfusion remained an independent predictor of short-term morbidity and infectious and pulmonary complications, a finding that surprised the authors.

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“You would expect to find that patients who receive a blood transfusion would be more apt to have a complication. Those patients are generally sicker… but when controlling for many of those factors, we were still able to find significance,” said Dr. Matulay, working with G. Joel DeCastro, MD, MPH, and colleagues.

Dr. Matulay did mention the caveat that the NSQIP database does not contain disease characteristics such as T staging, clinical staging, and pathologic staging, “so we can’t account for the fact that maybe these patients were more complex… had worse disease, or maybe there was something technical in the surgery that made them at higher risk for complications,” he said.

Dr. Matulay told Urology Times that the sheer volume of patients included was a particular strength of the study.

“I don’t think at an institutional level you’d be able to do this kind of analysis on blood transfusion,” he said.

Asked about clinical implications of the research, Dr. Matulay said, “I think that this would be a starting-off point to investigate our use of allogeneic blood transfusion, knowing that just like any other donor tissue, blood is going to stimulate an inflammatory response.”

The findings should also make urologists “conscientious” about performing blood transfusions, he said.

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