Higher Post-Nephrectomy Transfusion Rate Found

Blood transfusions after nephrectomy for renal masses may occur more frequently in general clinical practice than previously appreciated, according to researchers.

In a population-based study of 10,902 patients, the investigators found that 18.1% of patients overall required a perioperative blood transfusion (PBT), with the rate varying by type of procedure. Older patients and those with greater comorbidities had a greater likelihood of requiring a PBT, whereas those operated on by high-volume surgeons and high-volume hospitals had a decreased likelihood of requiring a PBT, investigators led by Robert Abouassaly, MD, of University Hospitals Case Medical Center in Cleveland, reported online ahead of print in BJU International.

“Patient and provider factors appear to contribute to the considerable variability that exists in the observed transfusion rate,” they concluded.

They also noted: “A more detailed understanding of these factors may help with respect to preoperative patient counseling and informed consent.”

The PBT rate after open radical nephrectomy (ORN), open partial nephrectomy (OPN), laparoscopic radical nephrectomy (LRN), and laparoscopic partial nephrectomy (LPN) were 28.2%, 12.7%, 9.2%, and 8.6%, respectively. The rates for patients younger than 50 years or who had a Charlson score of 0 were 11.2% and 14.5%, respectively, whereas the rates for patients aged 80 and older or who had Charlson scores of 3 or higher were 28.2% and 40.7%, respectively.

After adjusting for multiple variables, patients aged 70-80, 60-69, and 50-59 had a 2.5, 2.1, and 1.5 times increased likelihood of requiring a transfusion compared with patients younger than 50 years. A Charlson score of 3 was associated with a 3.5-fold increased likelihood of PBT compared with a Charlson score of 0. PN was associated with a 46% decreased likelihood of transfusion compared with RN. Compared with ORN, LRN, OPN, and LPN were associated with a 75%, 62%, and 76% decreased likelihood of PBT.

Gender and year of surgery were not associated with transfusion risk.

Dr. Abouassaly's group noted that the actual transfusion rate of 28.2% for ORN patients was unexpected because this is much higher than the rate found in previous studies. For example, in a study published by Wooju Jeong, MD, and colleagues in Urology (2011;77:819-824) that compared LRN and ORN for clinical stage T2 or lower renal cell carcinoma, the reported rates of blood transfusion for ORN and LRN were 4.3% and 3.6%, respectively. Dr. Abouassaly and his colleagues noted, however, that 88% of these tumors were stage pT1a or pT1b, which may have contributed to the lower rate of blood transfusion compared with their study. In addition, in a study of linked Surveillance, Epidemiology, and End Results-Medicare data,  Hung-Jui Tan, MD, and colleagues found an overall blood transfusion rate of 4.2% and 1.9% for ORN and LRN, respectively, according to a report in Cancer (2011;117:4184-4193).

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