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Safe to save blood in ovarian cancer surgery : time to change transfusion habits

Norbeck, Anna LU ; Bengtsson, Jesper ; Malander, Susanne LU orcid ; Asp, Mihaela LU orcid and Kannisto, Päivi LU (2024) In Acta Oncologica 63.
Abstract
Background: Patients with advanced ovarian cancer (AOC) undergoing surgery are often subjected to red blood cell (RBC) transfusions. Both anemia and RBC transfusion are associated with increased morbidity. The aim was to evaluate patient recovery after the implementation of patient blood management (PBM) strategies.

Methods: This retrospective cohort study included 354 patients with AOC undergoing surgery at Skane University Hospital Lund, Sweden, between January 2016 and December 2021. The gradual implementation of PBM strategies included restrictive RBC transfusion, tranexamic acid as standard medication before laparotomies and intravenous iron administered to patients with iron deficiency. Severe complications were defined as... (More)
Background: Patients with advanced ovarian cancer (AOC) undergoing surgery are often subjected to red blood cell (RBC) transfusions. Both anemia and RBC transfusion are associated with increased morbidity. The aim was to evaluate patient recovery after the implementation of patient blood management (PBM) strategies.

Methods: This retrospective cohort study included 354 patients with AOC undergoing surgery at Skane University Hospital Lund, Sweden, between January 2016 and December 2021. The gradual implementation of PBM strategies included restrictive RBC transfusion, tranexamic acid as standard medication before laparotomies and intravenous iron administered to patients with iron deficiency. Severe complications were defined as Clavien-Dindo (CD) grade ≥ 3a. Logistic and linear regression analyses were used to evaluate the differences between three consecutive periods.

Results: After the implementation of new strategies, 52% of the patients had at least one transfusion compared to 83% at baseline (p < 0.001). There was no difference in the rate of severe complications (CD ≥ 3a) between the groups, adjusted odds ratio 0.55 (95% CI 0.26–1.17). The mean difference in hemoglobin before chemotherapy was -1.32 g/L (95% CI -3.04 to -0.22) when adjusted for blood loss and days from surgery to chemotherapy. The length of stay (LOS) decreased from 8.5 days to 7.5 days (p 0.002).

Interpretation: The number of patients transfused were reduced by 31%. Despite a slight increase in anemia rate, severe complications (CD ≥ 3a) remained stable. The LOS was reduced, and chemotherapy was given without delay, indicating that PBM is feasible and without causing major severe effects on short-term recovery. (Less)
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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
ovarian cancer, patient blood management, red blood cell transfusion, intravenous iron, hemoglobin level
in
Acta Oncologica
volume
63
publisher
Taylor & Francis
ISSN
1651-226X
DOI
10.2340/1651-226X.2024.40435
language
English
LU publication?
yes
id
2ac970a7-fdd5-40f4-907f-a62642d7580f
date added to LUP
2024-09-26 14:20:36
date last changed
2024-09-26 14:55:04
@article{2ac970a7-fdd5-40f4-907f-a62642d7580f,
  abstract     = {{Background: Patients with advanced ovarian cancer (AOC) undergoing surgery are often subjected to red blood cell (RBC) transfusions. Both anemia and RBC transfusion are associated with increased morbidity. The aim was to evaluate patient recovery after the implementation of patient blood management (PBM) strategies.<br/><br/>Methods: This retrospective cohort study included 354 patients with AOC undergoing surgery at Skane University Hospital Lund, Sweden, between January 2016 and December 2021. The gradual implementation of PBM strategies included restrictive RBC transfusion, tranexamic acid as standard medication before laparotomies and intravenous iron administered to patients with iron deficiency. Severe complications were defined as Clavien-Dindo (CD) grade ≥ 3a. Logistic and linear regression analyses were used to evaluate the differences between three consecutive periods.<br/><br/>Results: After the implementation of new strategies, 52% of the patients had at least one transfusion compared to 83% at baseline (p &lt; 0.001). There was no difference in the rate of severe complications (CD ≥ 3a) between the groups, adjusted odds ratio 0.55 (95% CI 0.26–1.17). The mean difference in hemoglobin before chemotherapy was -1.32 g/L (95% CI -3.04 to -0.22) when adjusted for blood loss and days from surgery to chemotherapy. The length of stay (LOS) decreased from 8.5 days to 7.5 days (p 0.002).<br/><br/>Interpretation: The number of patients transfused were reduced by 31%. Despite a slight increase in anemia rate, severe complications (CD ≥ 3a) remained stable. The LOS was reduced, and chemotherapy was given without delay, indicating that PBM is feasible and without causing major severe effects on short-term recovery.}},
  author       = {{Norbeck, Anna and Bengtsson, Jesper and Malander, Susanne and Asp, Mihaela and Kannisto, Päivi}},
  issn         = {{1651-226X}},
  keywords     = {{ovarian cancer; patient blood management; red blood cell transfusion; intravenous iron; hemoglobin level}},
  language     = {{eng}},
  month        = {{09}},
  publisher    = {{Taylor & Francis}},
  series       = {{Acta Oncologica}},
  title        = {{Safe to save blood in ovarian cancer surgery : time to change transfusion habits}},
  url          = {{http://dx.doi.org/10.2340/1651-226X.2024.40435}},
  doi          = {{10.2340/1651-226X.2024.40435}},
  volume       = {{63}},
  year         = {{2024}},
}