Sp. Benoist et al., Predictive factors for perioperative blood transfusions in rectal resection for cancer: A multivariate analysis of a group of 212 patients, SURGERY, 129(4), 2001, pp. 433-439
Background. In colorectal cancer surgery, allogeneic blood transfusions hav
e reportedly been associated with higher rates of postoperative complicatio
ns and tumor recurrence. However, because of the increased cost of alternat
ive types of blood transfusions (eg, the use of autologous blood or erythro
poietin administration), their routine use cannot be recommended. This stud
y evaluated the risk factors for perioperative blood transfusions in resect
ion for rectal cancer in order to identify patients who could benefit from
these methods.
Methods. From 1990 to 1997, 212 consecutive patients who underwent elective
rectal resection for cancer were reviewed. The associations between periop
erative heterologous blood transfusion and 18 patient-, tumor-, surgical-,
and treatment-related variables were assessed by univariate and multivariat
e analysis.
Results. Of the 212 patients, 72 (34%) received transfusions. Multivariate
analysis revealed that 5 preoperative variables were significant risk facto
rs for preoperative blood transfusion: age > 65 years (P = .03), body mass
index > 27 kg/m(2) (P = .04), preoperative hemoglobin less than or equal to
12.5 g/dL (P < .0001), American Society of Anesthesiologists status > 2 (P
= .024), and additional surgical procedures (P = .018). In patients with a
nemia, the risk of transfusion was at least 47% in patients with 1 other ri
sk factor or more. In nonanemic patients, the risk of transfusion was under
11 % in patients with 1 risk factor or none, but increased to 47 % in thos
e with 2 or more risk factors.
Conclusions. Our analysis of risk factors for perioperative blood transfusi
on in rectal resection for cancer must be considered to constitute guidelin
es for a more responsible use of the expensive alternatives to allogeneic b
lood transfusion.