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NUMBER OF BLOOD UNITS TRANSFUSED AND OUTCOMES AFTER HEPATECTOMY.
Faisal S. Jehan
*1, Mohammad R. Khreiss
2, Hassan Aziz
31Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY; 2Banner - University Medical Center Tucson, Tucson, AZ; 3University of Iowa Hospitals and Clinics, Iowa City, IA
Introduction: Previous studies have reported that blood transfusion is associated with increased risk of worse outcomes in patients following hepatectomy. However, the independent effect of number of blood transfusions and its association with outcomes has not been studied.
Methods: We performed a 3-year (2019-2021) retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Liver participant user file (PUF) and included all patients that underwent hepatectomy. Primary outcome was mortality and liver-specific and overall morbidity depending upon the numbers of blood transfusions. Multivariable logistic regression analysis was used to estimate the effect of number of blood transfusion on 30-day mortality and morbidity.
Results: A total of 15139 patients underwent hepatectomy, of which 10.6% (1599) patients received at least one or more blood transfusions. Patients who received blood transfusion had a higher mortality (4% vs. 0.8%,
p<0.01) when compared to those who did not receive blood transfusion. Patients who received blood transfusion had rates of post hepatectomy liver failure (12.3% vs. 3.3%,
p<0.01), and bile leak (4% vs. 0.8%,
p<0.01) when compared to those who did not receive blood transfusion. On adjusted regression analysis, patients undergoing hepatectomy who receives 1 units had higher morbidity (OR2.5,
p<0.01) but no difference in mortality (OR1.4,
p<0.07). Patients who received 2 units or more higher morbidity as well as mortality as shown in
Figure 1.
Conclusion: One in ten patients undergoing hepatectomy received a transfusion post op. Transfusion of even one unit of blood after hepatectomy independently increases overall morbidity while transfusion of two or more units is independently associated with mortality. The mortality continues to increase exponentially with each increase in unit of blood transfusion.
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