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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 11/2015

01-11-2015 | Original Article

Significant Variation in Blood Transfusion Practice Persists following Upper GI Cancer Resection

Authors: Christopher T. Aquina, Neil Blumberg, Christian P. Probst, Adan Z. Becerra, Bradley J. Hensley, James C. Iannuzzi, Maynor G. Gonzalez, Andrew-Paul Deeb, Katia Noyes, John R. T. Monson, Fergal J. Fleming

Published in: Journal of Gastrointestinal Surgery | Issue 11/2015

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Abstract

Purpose

Perioperative blood transfusions are costly and linked to adverse clinical outcomes. We investigated the factors associated with variation in blood transfusion utilization following upper gastrointestinal cancer resection and its association with infectious complications.

Methods

The Statewide Planning and Research Cooperative System was queried for elective esophagectomy, gastrectomy, and pancreatectomy for malignancy in NY State from 2001 to 2013. Bivariate and hierarchical logistic regression analyses were performed to assess the factors associated with receiving a perioperative allogeneic red blood cell transfusion. Additional multivariable analysis examined the relationship between transfusion and infectious complications.

Results

Among 14,875 patients who underwent upper GI cancer resection, 32 % of patients received a perioperative blood transfusion. After controlling for patient, surgeon, and hospital-level factors, significant variation in transfusion rates was present across both surgeons (p < 0.0001) and hospitals (p < 0.0001). Receipt of a blood transfusion was also independently associated with wound infection (OR = 1.68, 95% CI = 1.47 and 1.91), pneumonia (OR = 1.98, 95% CI = 1.74 and 2.26), and sepsis (OR = 2.49, 95% CI = 2.11 and 2.94).

Conclusion

Significant variation in perioperative blood transfusion utilization is present at both the surgeon and hospital level. These findings are unexplained by patient-level factors and other known hospital characteristics, suggesting that variation is due to provider preferences and/or lack of standardized transfusion protocols. Implementing institutional transfusion guidelines is necessary to limit unwarranted variation and reduce infectious complication rates.
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Metadata
Title
Significant Variation in Blood Transfusion Practice Persists following Upper GI Cancer Resection
Authors
Christopher T. Aquina
Neil Blumberg
Christian P. Probst
Adan Z. Becerra
Bradley J. Hensley
James C. Iannuzzi
Maynor G. Gonzalez
Andrew-Paul Deeb
Katia Noyes
John R. T. Monson
Fergal J. Fleming
Publication date
01-11-2015
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 11/2015
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-015-2903-3

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