Perioperative red blood cell transfusion is associated with poor functional outcome and overall survival in patients with newly diagnosed glioblastoma

Red blood cell transfusion in canine and feline patients under general anaesthesia

OBJECTIVE

To describe a referral hospital population of dogs and cats receiving red blood cell (RBC) transfusions during general anaesthesia (GA).

STUDY DESIGN

Retrospective cohort study.

ANIMALS

Cats and dogs.

METHODS

Between 2016 and 2021, animals that received RBC products during GA were identified using clinical records. Signalment, physical examination and clinical pathology findings, reason for GA, blood product details and timing of transfusion in relation to commencement of GA, American Society of Anesthesiologists (ASA) status and survival to discharge were collected. Normality was assessed using the Shapiro-Wilks test. Pearson's chi-squared or Wilcoxon-Mann-Whitney U tests was used to investigate the relationship between underlying disease, timing of transfusion and ASA status on survival; p < 0.05.

RESULTS

A total of 2137 animals received RBC transfusions during the study period. Of these, 332 occurred under GA and 244 patients were excluded, leaving 88 animals that met the study criteria. These comprised 18 cats and 70 dogs. The most common reason for RBC transfusion under GA was for surgical management of a haemoabdomen (23/88). Animals were significantly more likely to survive if their ASA status was I or II (p = 0.031). Overall survival was not affected by transfusion start time; however, animals with ASA status of IV or V were significantly more likely to survive when RBC transfusion was started before GA (p < 0.001). There was no significant difference in survival (p = 0.876), or length of hospital stay (p = 0.854) based on volume of RBC product administered. No transfusion reactions were identified in this group of animals in this study. Overall survival was 79.5%.

CONCLUSIONS AND CLINICAL RELEVANCE

Noncritical animals (ASA I and II) were more likely to survive in this population, but more compromised animals (ASA IV and V) benefitted from starting the transfusion prior to GA.

Red blood cell transfusion in patients undergoing elective primary glioblastoma resection

BACKGROUND

Red blood cell (RBC) transfusion in patients undergoing major elective cranial surgery is associated with increased postoperative morbidity and mortality. This study aims to identify the clinical outcome of transfused glioblastoma patients undergoing primary surgical tumor resection and identify risk factors for RBC transfusion.

MATERIAL AND METHODS

Between 2009 and 2019, 406 patients underwent elective primary glioblastoma resection. For multivariate analysis to assess risk factors for RBC transfusion, logistic regression was conducted. The impact of RBC transfusion on overall survival was assessed using Kaplan-Meier analysis.

RESULTS

In total, 36 (8.9%) patients received RBC transfusion. Preoperative anemia rate was significantly higher in transfused patients compared to patients without RBC transfusion (33.3 vs 6.5%; p<0.0001). Postoperative complications as well as hospital length of stay (LOS) (p<0.0001) were significantly increased in transfused patients compared to non-transfused patients. After multivariate analysis, risk factors for RBC transfusion were preoperative anemia (p<0.0001), intraoperative blood loss (p<0.0001), female gender (p=0.0056) and radiation (p=0.0064). Kaplan-Meier curves revealed that RBC transfusion and being elderly (age ≥75 years) were relevant for overall survival.

DISCUSSION

RBC transfusion is associated with increased postoperative morbidity and mortality in patients undergoing elective primary glioblastoma resection. Preoperative anemia and intraoperative blood loss are major risk factors for RBC transfusion. Preoperative anemia management and blood conservation strategies are crucial in patients undergoing elective primary glioblastoma resection.

Risk Factors Involved in the Blood (Leukocyte-Depleted Suspended Red Blood Cells and Plasma) Transfusion During Glioma Operations

Background

The use of blood transfusion in surgery is increasing, and the blood supply is getting tighter. The number of glioma surgeries is increasing year by year, and reports of studies on blood transfusion in glioma surgery are relatively rare.

Purpose

To investigate the risk factors for intraoperative blood (leukocyte-depleted suspended red blood cells and plasma) transfusion in glioma patients.

Patients and Methods

We retrospectively analyzed the data of 200 glioma patients who had been operated on in a general teaching hospital in China from January 1, 2018 to March 31, 2022. In terms of whether blood transfusion (leukocyte-depleted suspended red blood cells and plasma) was used intraoperatively, patients were divided into a transfusion group (n=82) and a non-transfusion group (n=118). Multivariate Logistic regression analysis was conducted to identify the risk factors for intraoperative blood transfusion.

Results

The rate of intraoperative transfusion rate in the 200 glioma patients was 41%. Multivariate Logistic regression analysis showed that operation time, intraoperative blood loss ≥500 mL, vascular involvement, and the extent of tumor resection (total resection) were independent risk factors for intraoperative blood transfusion (P<0.05). Patient height was a protective factor against intraoperative blood transfusion (P<0.05).

Conclusion

The risk of intraoperative blood transfusion was higher in glioma patients with longer operation time, more intraoperative blood loss, vascular involvement, and total tumor resection. Clinically, efforts should be made to avoid these transfusion-related risk factors to minimize the risk of blood transfusion in patients.

Unplanned intensive care unit readmission after surgical treatment in patients with newly diagnosed glioblastoma - forfeiture of surgically achieved advantages?

Postoperative intensive care unit (ICU) monitoring is an established option to ensure patient safety after resection of newly diagnosed glioblastoma. In contrast, secondary unplanned ICU readmission following complicating events during the initial postoperative course might be associated with severe morbidity and impair initially intended surgical benefit. In the present study, we assessed the prognostic impact of secondary ICU readmission and aimed to identify preoperatively ascertainable risk factors for the development of such adverse events in patients treated surgically for newly diagnosed glioblastoma. Between 2013 and 2018, 240 patients were surgically treated for newly diagnosed glioblastoma at the authors' neuro-oncological center. Secondary ICU readmission was defined as any unplanned admission to the ICU during initial hospital stay. A multivariable logistic regression analysis was performed to identify preoperatively measurable risk factors for unplanned ICU readmission. Nineteen of 240 glioblastoma patients (8%) were readmitted to the ICU. Median overall survival of patients with unplanned ICU readmission was 9 months compared to 17 months for patients without secondary ICU readmission (p=0.008). Multivariable analysis identified "preoperative administration of dexamethasone > 7 days" (p=0.002) as a significant and independent predictor of secondary unplanned ICU admission. Secondary ICU readmission following surgery for newly diagnosed glioblastoma is significantly associated with poor survival and thus may negate surgically achieved prerequisites for further treatment. This underlines the indispensability of precise patient selection as well as the importance of further scientific debate on these highly relevant aspects for patient safety.

Safety of Intraoperative Cell Salvage in Cancer Surgery: An Updated Meta-Analysis of the Current Literature

Background

Allogeneic blood transfusions in oncologic surgery are associated with increased recurrence and mortality. Adverse effects on outcome could be reduced or avoided by using intraoperative autologous blood cell salvage (IOCS). However, there are concerns regarding the safety of the autologous IOCS blood. Previous meta-analyses from 2012 and 2020 did not identify increased risk of cancer recurrence after using autologous IOCS blood. The objective of this review was to reassess a greater number of IOCS-treated patients to present an updated and more robust analysis of the current literature.

Methods

This systematic review includes full-text articles listed in PubMed, Cochrane, Cochrane Reviews, and Web of Science. We analyzed publications that discussed cell salvage or autotransfusion combined with the following outcomes: cancer recurrence, mortality, survival, allogeneic transfusion rate and requirements, length of hospital stay (LOS). To rate the strength of evidence, a Grading of Recommendations Assessment, Development and Evaluation (GRADE) of the underlying evidence was applied.

Results

In the updated meta-analysis, 7 further observational studies were added to the original 27 observational studies included in the former 2020 analysis. Studies compared either unfiltered (n = 2,311) or filtered (n = 850) IOCS (total n = 3,161) versus non-IOCS use (n = 5,342). Control patients were either treated with autologous predonated blood (n = 484), with allogeneic transfusion (n = 4,113), or did not receive a blood transfusion (n = 745). However, the current literature still contains only observational studies on these topics, and the strength of evidence remains low. The risk of cancer recurrence was reduced in recipients of autologous salvaged blood with or without LDF (odds ratio [OR] 0.76, 95% confidence interval [CI]: 0.64-0.90) compared to nontransfused patients or patients with allogeneic transfusion. There was no difference in mortality (OR 0.95, 95% CI: 0.71-1.27) and LOS (mean difference -0.07 days, 95% CI: -0.63 to 0.48) between patients treated with IOCS blood or those in whom IOCS was not used. Due to high heterogeneity, transfusion rates or volumes could not be analyzed.

Conclusion

Randomized controlled trials comparing mortality and cancer recurrence rate of IOCS with or without LDF filtration versus allogeneic blood transfusion were not found. Outcome was similar or better in patients receiving IOCS during cancer surgery compared to patients with allogeneic blood transfusion or nontransfused patients.