Effect of Intraoperative Red Blood Cell Transfusion on Postoperative Complications After Open Radical Cystectomy: Old Versus Fresh Stored Blood.

Abstract

Transfusion is associated with adverse clinical outcomes. The effect of intraoperative transfusion with fresh versus old blood on postoperative complications was compared in patients undergoing open radical cystectomy. Intraoperative transfusion was predictive of postoperative complications. However, there was no difference in the incidence of postoperative complications between transfusions with old blood and fresh blood. Intraoperative transfusion per se, not the storage duration of red blood cells, was associated with increased postoperative complications. Introduction: Transfusion with red blood cells (RBCs) is associated with adverse clinical outcomes. We determined whether an intraoperative RBC transfusion is related to postoperative complications in patients undergoing open radical cystectomy. We also compared the effect of transfusion with fresh versus old blood on postoperative complications. Patients and Methods: A total of 261 patients undergoing open radical cystectomy were divided into no-transfusion or transfusion groups. Transfused patients were divided according to RBC storage duration (fresh, 14 days; old, > 14 days). Postoperative complications, such as infection, paralytic ileus, urinary tract obstruction, and anastomotic leak, were noted. Results: Infection (26.5%) was the most common postoperative complication, followed by procedural (17.6%), gastrointestinal (16.7%), renal (13.7%), and vascular (10.5%) problems. Age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.00-1.07; P ¼ .029), urinary diversion with a neobladder (OR, 2.30; 95% CI, 1.29-4.11; P ¼ .005), and intraoperative RBC transfusion (OR, 1.77; 95% CI, 1.02-3.07; P ¼ .042) were independent predictors of postoperative complications in a binary logistic analysis. Patients (n ¼ 172; old blood, n ¼ 47; fresh blood, n ¼ 116; mixed blood, n ¼ 9) who received an intraoperative RBC transfusion had a higher incidence of postoperative complications than those (n ¼ 89) who did not undergo intraoperative transfusion (65.1% vs. 49.4%, P < .05). No difference in the incidence of postoperative complications between transfusions with old blood and fresh blood was observed (63.8% vs. 65.5%). Conclusion: Intraoperative RBC transfusion is associated with increased postoperative complications in patients undergoing open radical cystectomy. The RBC storage duration may not affect the incidence of postoperative complications in this study population.