Commentary: Perioperative transfusion-Awakening the immunologic beast, or alerting us to unrecognized frailty?

Colon Cancer Surgery: Does Preoperative Blood Transfusion Influence Short-Term Postoperative Outcomes?

BACKGROUND

While perioperative red blood cell transfusion has been widely associated with poor surgical outcomes, few studies have focused specifically on the preoperative transfusional risk-benefit ratio. The aim of the present study was to evaluate the effects of preoperative red blood cell transfusion on short-term surgical outcomes in a cohort of anemic colon cancer patients.

METHODS

Moderate and severe anemic patients undergoing colectomy for cancer were divided into two groups based upon the receipt of preoperative transfusion and compared in terms of short-term outcomes.

RESULTS

A total of 271 patients with moderate or severe anemia were identified, 93 (34.3%) of whom were preoperatively transfused with a median of two units of packed red blood cells per patient (interquartile range: 2-4 units). The overall morbidity rate did not differ significantly between the two groups (35.5% vs. 36.2%; p = 0.63), while an increased incidence of major morbidity (Clavien-Dindo grade > 3a) observed in transfused patients [14% vs. 6.2% respectively; odds ratio (OR): 2.47, 95% confidence interval (CI): 1.06-5.75; p = 0.03]. The increase in major morbidity was confirmed by multivariate analysis, adjusted for potential confounders (OR: 3.45; 95% CI: 1.32-9.04; p = 0.01).

CONCLUSIONS

Preoperative blood transfusion is associated with severe postoperative complications following colectomy in moderate and severe anemic cancer patients. Further studies are needed to establish an optimal preoperative transfusional cutoff value to optimize postoperative outcomes and balance clinical costs.