Intraoperative Blood Transfusion Is Associated With Increased Risk of Venous Thromboembolism After Radical Cystectomy

医学 膀胱切除术 输血 外科 静脉血栓栓塞 膀胱癌 癌症 血栓形成 内科学
作者
Amanda A. Myers,Igor Frank,Paras Shah,Robert F. Tarrell,Bryce Baird,Chandler D. Dora,R. Jeffrey Karnes,R. Houston Thompson,Matthew K. Tollefson,Stephen A. Boorjian,Timothy D. Lyon
出处
期刊:The Journal of Urology [Lippincott Williams & Wilkins]
卷期号:209 (3): 525-531 被引量:2
标识
DOI:10.1097/ju.0000000000003094
摘要

No AccessJournal of UrologyAdult Urology1 Mar 2023Intraoperative Blood Transfusion Is Associated With Increased Risk of Venous Thromboembolism After Radical Cystectomy Amanda Myers, Igor Frank, Paras H. Shah, Robert F. Tarrell, Bryce Baird, Chandler Dora, R. Jeffrey Karnes, R. Houston Thompson, Matthew K. Tollefson, Stephen A. Boorjian, and Timothy D. Lyon Amanda MyersAmanda Myers https://orcid.org/0000-0002-5219-2978 Department of Urology, Mayo Clinic, Jacksonville, Florida More articles by this author , Igor FrankIgor Frank Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author , Paras H. ShahParas H. Shah Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author , Robert F. TarrellRobert F. Tarrell Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota More articles by this author , Bryce BairdBryce Baird Department of Urology, Mayo Clinic, Jacksonville, Florida More articles by this author , Chandler DoraChandler Dora Department of Urology, Mayo Clinic, Jacksonville, Florida More articles by this author , R. Jeffrey KarnesR. Jeffrey Karnes Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author , R. Houston ThompsonR. Houston Thompson Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author , Matthew K. TollefsonMatthew K. Tollefson Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author , Stephen A. BoorjianStephen A. Boorjian Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author , and Timothy D. LyonTimothy D. Lyon *Correspondence: Department of Urology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 telephone: 904-953-7330; E-mail Address: [email protected] https://orcid.org/0000-0001-9251-3687 Department of Urology, Mayo Clinic, Jacksonville, Florida Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003094AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Our objective was to examine whether perioperative blood transfusion is associated with venous thromboembolism following radical cystectomy adjusting for both patient- and disease-related factors. Materials and Methods: Patients who underwent radical cystectomy for bladder cancer from 1980-2020 were identified in the Mayo Clinic cystectomy registry. Blood transfusion during the initial postoperative hospitalization was analyzed as a 3-tiered variable: no transfusion, postoperative transfusion alone, or intraoperative with or without postoperative transfusion. The primary outcome was venous thromboembolism within 90 days of radical cystectomy. Associations between clinicopathological variables and 90-day venous thromboembolism were assessed using multivariable logistic regression, with transfusion analyzed as both a categorical and a continuous variable. Results: A total of 3,755 radical cystectomy patients were identified, of whom 162 (4.3%) experienced a venous thromboembolism within 90 days of radical cystectomy. Overall, 2,112 patients (56%) received a median of 1 (IQR: 0-3) unit of blood transfusion, including 811 (38%) with intraoperative transfusion only, 572 (27%) with postoperative transfusion only, and 729 (35%) with intraoperative and postoperative transfusion. On multivariable analysis, intraoperative with or without postoperative blood transfusion was associated with a significantly increased risk of venous thromboembolism (adjusted OR 1.73, 95% CI 1.17-2.56, P = .002). Moreover, when analyzed as a continuous variable, each unit of blood transfused intraoperatively was associated with 7% higher odds of venous thromboembolism (adjusted OR 1.07, 95% CI 1.01-1.13, P = .03). Conclusions: Intraoperative blood transfusion was significantly associated with venous thromboembolism within 90 days of radical cystectomy. To ensure optimal perioperative outcomes, continued effort to limit blood transfusion in radical cystectomy patients is warranted. References 1. The controversy surrounding surgical care improvement project–venous thromboembolism process measures. JAMA Surg. 2015; 150(6):527-528. Crossref, Medline, Google Scholar 2. . Procedure-specific risks of thrombosis and bleeding in urological cancer surgery: systematic review and meta-analysis. Eur Urol. 2018; 73(2):242-251. Crossref, Medline, Google Scholar 3. . Timing, incidence and risk factors for venous thromboembolism in patients undergoing radical cystectomy for malignancy: a case for extended duration pharmacological prophylaxis. J Urol. 2014; 191(4):943-947. Link, Google Scholar 4. . Associations of specific postoperative complications with costs after radical cystectomy. BJU Int. 2018; 121(3):428-436. Crossref, Medline, Google Scholar 5. . Red blood cells mediate the onset of thrombosis in the ferric chloride murine model. Blood. 2013; 121(18):3733-3741. Crossref, Medline, Google Scholar 6. . Role of red blood cells in haemostasis and thrombosis. ISBT Sci Ser. 2017; 12(1):176-183. Crossref, Medline, Google Scholar 7. . Stored red blood cells selectively activate human neutrophils to release IL-8 and secretory PLA2. Shock. 2000; 13(1):29-33. Crossref, Medline, Google Scholar 8. . Association of perioperative red blood cell transfusions with venous thromboembolism in a North American Registry. JAMA Surg. 2018; 153(9):826-833. Crossref, Medline, Google Scholar 9. . Association of blood transfusion and venous thromboembolism after colorectal cancer resection. Thromb Res. 2012; 129(5):568-572. Crossref, Medline, Google Scholar 10. . Risk factors for venous thromboembolism in cancer: novel findings from the Vienna Cancer and Thrombosis Study (CATS). Thromb Res. 2014; 133(suppl 2):S39-S43. Crossref, Medline, Google Scholar 11. . The impact of perioperative blood transfusion on cancer recurrence and survival following radical cystectomy. Eur Urol. 2013; 63(5):839-845. Crossref, Medline, Google Scholar 12. . Perioperative blood transfusion promotes worse outcomes of bladder cancer after radical cystectomy: a systematic review and meta-analysis. PLoS One. 2015; 10(6):e0130122. Medline, Google Scholar 13. . Risk factors for venous thromboembolic events in cancer patients. Ann Oncol. 2006; 17(2):297-303. Crossref, Medline, Google Scholar 14. . Incidence and effect of thromboembolic events in radical cystectomy patients undergoing preoperative chemotherapy for muscle-invasive bladder cancer. Clin Genitourin Cancer. 2017; S1558-7673(17)30232-X. Google Scholar 15. . Patterns and timing of perioperative blood transfusion and association with outcomes after radical cystectomy. Urol Oncol Semin Original Invest. 2021; 39(8):496.e1-496.e8. Crossref, Medline, Google Scholar 16. . Efficacy and safety of intraoperative tranexamic acid infusion for reducing blood transfusion during open radical cystectomy. Urology. 2016; 92:57-62. Crossref, Medline, Google Scholar 17. . Safety and efficacy of extended duration of thromboembolic prophylaxis following radical cystectomy: an initial institutional experience. Urol Pract. 2016; 3(6):462-467. Link, Google Scholar 18. . Elevated levels of thrombin-generating microparticles in stored red blood cells. Vox Sang. 2013; 105(1):11-17. Crossref, Medline, Google Scholar 19. . Venous thromboembolism after major cancer surgery: temporal trends and patterns of care. JAMA Surg. 2014; 149(1):43-49. Crossref, Medline, Google Scholar 20. . Temporal trends in venous thromboembolism after radical cystectomy. Urol Oncol Semin Original Invest. 2018; 36(8):361.e15-361.e21. Crossref, Medline, Google Scholar 21. . Implementation of a perioperative venous thromboembolism prophylaxis program for patients undergoing radical cystectomy on an enhanced recovery after surgery protocol. Eur Urol Focus. 2020; 6(1):74-80. Crossref, Medline, Google Scholar 22. . Rethinking the one-size-fits-most approach to venous thromboembolism prophylaxis after radical cystectomy. Urol Oncol Semin Original Invest. 2020; 38(10):797.e1-797.e6. Crossref, Medline, Google Scholar 23. . Pathophysiology of venous thrombosis. Thromb Res. 2009; 123(suppl 4):S30-S34. Crossref, Medline, Google Scholar 24. . Tranexamic acid in patients undergoing noncardiac surgery. N Engl J Med. 2022; 386(21):1986-1997. Crossref, Medline, Google Scholar 25. . The safety and short-term outcomes of leukocyte depleted autologous transfusions during radical cystectomy. Urology. 2020; 135:106-110. Crossref, Medline, Google Scholar 26. . Robot-assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer (RAZOR): an open-label, randomised, phase 3, non-inferiority trial. Lancet. 2018; 391(10139):2525-2536. Crossref, Medline, Google Scholar Support: None. Conflict of Interest: SAB: Consultant: Protara, Prokarium, FerGene, Ferring; TDL: Consultant: Bristol Myers Squibb, ImmunityBio. Ethics Statement: This study received Institutional Review Board approval (IRB No. 21-007383). Author Contributions: Conception and design: AAM, PHS, BAB, RJK, RHT, MKT, TDL; data analysis and interpretation: IF, PHS, RFT, CDD, RJK, MKT, SAB; data acquisition: RFT, MKT; critical revision of the manuscript for scientific and factual content: IF, PHS, CDD, RJK, RHT, MKT, SAB; drafting the manuscript: AAM, RFT, BAB, TDL; statistical analysis: AAM, RFT; supervision: IF, PHS, BAB, CDD, RJK, RHT, SAB, TDL. Editor's Note: This article is the second of 5 published in this issue for which Category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 647 and 648. See Editorial on page 471. © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byCallum J and Siemens D (2023) We Should Redouble Efforts to Minimize Transfusions in Urological SurgeryJournal of Urology, VOL. 209, NO. 3, (471-473), Online publication date: 1-Mar-2023.Siemens D (2022) This Month in Adult UrologyJournal of Urology, VOL. 209, NO. 3, (457-458), Online publication date: 1-Mar-2023. Volume 209Issue 3March 2023Page: 525-531Supplementary Materials Peer Review Report Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.Keywordscystectomyvenous thromboembolismurinary bladder neoplasmsMetricsAuthor Information Amanda Myers Department of Urology, Mayo Clinic, Jacksonville, Florida More articles by this author Igor Frank Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author Paras H. Shah Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author Robert F. Tarrell Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota More articles by this author Bryce Baird Department of Urology, Mayo Clinic, Jacksonville, Florida More articles by this author Chandler Dora Department of Urology, Mayo Clinic, Jacksonville, Florida More articles by this author R. Jeffrey Karnes Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author R. Houston Thompson Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author Matthew K. Tollefson Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author Stephen A. Boorjian Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author Timothy D. Lyon Department of Urology, Mayo Clinic, Jacksonville, Florida Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota *Correspondence: Department of Urology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 telephone: 904-953-7330; E-mail Address: [email protected] More articles by this author Expand All Support: None. Conflict of Interest: SAB: Consultant: Protara, Prokarium, FerGene, Ferring; TDL: Consultant: Bristol Myers Squibb, ImmunityBio. Ethics Statement: This study received Institutional Review Board approval (IRB No. 21-007383). Author Contributions: Conception and design: AAM, PHS, BAB, RJK, RHT, MKT, TDL; data analysis and interpretation: IF, PHS, RFT, CDD, RJK, MKT, SAB; data acquisition: RFT, MKT; critical revision of the manuscript for scientific and factual content: IF, PHS, CDD, RJK, RHT, MKT, SAB; drafting the manuscript: AAM, RFT, BAB, TDL; statistical analysis: AAM, RFT; supervision: IF, PHS, BAB, CDD, RJK, RHT, SAB, TDL. Editor's Note: This article is the second of 5 published in this issue for which Category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 647 and 648. See Editorial on page 471. Advertisement PDF downloadLoading ...
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