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

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. 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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 ...