Patient blood management improves outcome in oncologic surgery

V Keding; K Zacharowski; WO Bechstein; P Meybohm; AA Schnitzbauer

doi:10.1055/s-0037-1604853

Zeitschrift für Gastroenterologie, Table of Contents

Z Gastroenterol 2017; 55(08): e57-e299
DOI: 10.1055/s-0037-1604853

Kurzvorträge

Dünndarm und Dickdarm, Proktologie

Kolonkarzinom – Therapie und Biomarker: Donnerstag, 14 September 2017, 09:30 – 10:58, Barcelona/Forschungsforum 5

Georg Thieme Verlag KG Stuttgart · New York

Patient blood management improves outcome in oncologic surgery

Authors

V Keding

¹Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt am Main, Klinik für Allgemein- und Viszeralchirurgie, Frankfurt am Main, Deutschland
K Zacharowski

²Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt am Main, Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Frankfurt am Main, Deutschland
WO Bechstein

¹Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt am Main, Klinik für Allgemein- und Viszeralchirurgie, Frankfurt am Main, Deutschland
P Meybohm

²Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt am Main, Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Frankfurt am Main, Deutschland
AA Schnitzbauer

¹Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt am Main, Klinik für Allgemein- und Viszeralchirurgie, Frankfurt am Main, Deutschland

Abstract

Full Text

Objective:

To evaluate the role of patient blood management (PBM) on outcome in oncologic surgery.

Summary Background Data:

PBM is a multimodal approach to manage anemia, minimize blood loss, and harness tolerance to anemia to improve patient outcome. Our hypothesis was that PBM improves 2-year overall survival (OS) in oncologic surgery.

Patients and methods:

Retrospective, single-center cohort 2 years before/after PBM-implementation. Primary outcome was 2-year OS. Sample-size calculation predetermined analysis of 800 patients to detect a difference of 10% better survival.

Results:

Between 2011 and 2015, 848 patients underwent oncologic surgery, 391 before, 457 after PBM-implementation. PBM-patients were older (64.8 ± 13.6 vs. 66.9 ± 12.4 years, p = 0.019), had less gastrointestinal (45.8% vs. 31.5%; p < 0.001), but more renal disease (6.1% vs. 10.3%; p = 0.034). Patient-proportion with normal hemoglobin-values pre-surgery was higher with PBM (38.3% vs. 61.7%; p < 0.001), transfusions were reduced (5.5 ± 11.1 vs. 3.0 ± 6.9 units/patient; p < 0.001; 62.4% vs. 40.9% transfused; p < 0.001). Two-year OS was better with PBM (67.0% vs. 80.1%; p = 0.001). COX-regression revealed age (HR: 1.02, 95%CI: 1.00 – 1.04, p = 0.008), gastrointestinal concomitant disease (HR: 1.86, 95%CI: 1.26 – 2.76, p = 0.002), transfused units (HR: 1.03, 95%CI: 1.00 – 1.05, p = 0.023) and complications with Dindo-Clavien > 3a (HR: 7.52, 95%CI: 4.50 – 12.57, p < 0.001) as independent risk factors for death; normal hemoglobin-values pre-surgery (HR: 0.43, 95%CI: 0.29 – 0.65, p < 0.001) were protective. ROC-analysis discriminated 1 unit of blood (AUC-ROC 0.729; sensitivity 75%/specificity 61%) as threshold for impaired survival.

Conclusions:

PBM orchestrating normal hemoglobin-values pre-surgery and restrictive transfusion-regimens was associated with improved 2-year outcome after oncologic surgery.