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 ...
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
英姑应助WWWWH采纳,获得10
刚刚
风吹不到海湾完成签到,获得积分10
刚刚
March应助wwrjj采纳,获得10
刚刚
SciGPT应助开放的寒梅采纳,获得10
刚刚
1秒前
漂亮的笑萍完成签到,获得积分10
2秒前
可爱柠檬完成签到,获得积分10
2秒前
2秒前
等待蚂蚁完成签到 ,获得积分10
3秒前
chen完成签到,获得积分10
3秒前
ZHDNCG发布了新的文献求助10
3秒前
123123发布了新的文献求助10
4秒前
慕青应助0713采纳,获得10
4秒前
Even发布了新的文献求助10
4秒前
5秒前
5秒前
打打应助winwin采纳,获得10
5秒前
6秒前
6秒前
汉堡包应助美满花生采纳,获得10
6秒前
6秒前
黄腾完成签到,获得积分10
7秒前
搜索v完成签到 ,获得积分10
7秒前
7秒前
7秒前
8秒前
9秒前
李健应助naomi采纳,获得10
10秒前
Andy1201完成签到,获得积分10
10秒前
林小不脏完成签到,获得积分10
10秒前
enen发布了新的文献求助30
10秒前
greenspanee发布了新的文献求助10
10秒前
10秒前
10秒前
Loone发布了新的文献求助10
12秒前
Akim应助lunar采纳,获得10
12秒前
元谷雪发布了新的文献求助10
13秒前
刘敏123456完成签到,获得积分20
13秒前
油菜的星星完成签到,获得积分10
13秒前
马某某某某某完成签到,获得积分10
13秒前
高分求助中
Picture Books with Same-sex Parented Families: Unintentional Censorship 700
ACSM’s Guidelines for Exercise Testing and Prescription, 12th edition 500
Nucleophilic substitution in azasydnone-modified dinitroanisoles 500
不知道标题是什么 500
Indomethacinのヒトにおける経皮吸収 400
Phylogenetic study of the order Polydesmida (Myriapoda: Diplopoda) 370
Effective Learning and Mental Wellbeing 300
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3974426
求助须知:如何正确求助?哪些是违规求助? 3518788
关于积分的说明 11195842
捐赠科研通 3254946
什么是DOI,文献DOI怎么找? 1797649
邀请新用户注册赠送积分活动 877037
科研通“疑难数据库(出版商)”最低求助积分说明 806130