Blood Transfusions in Radical Prostatectomy: A Contemporary Population-based Analysis - 06/02/12

Doi : 10.1016/j.urology.2011.08.079

Jan Schmitges ^a,^b,^⁎ , Maxine Sun ^b, Firas Abdollah ^c, Quoc-Dien Trinh ^b,^d, Claudio Jeldres ^b, Lars Budäus ^e, Marco Bianchi ^c, Jens Hansen ^a, Thorsten Schlomm ^a, Paul Perrotte ^f, Markus Graefen ^a, Pierre I. Karakiewicz ^b
^a Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
^b Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montreal, Canada
^c Department of Urology, Vita Salute San Raffaele University, Milan, Italy
^d Vattikuti Urology Institute, Detroit, MI
^e Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
^f Department of Urology, University of Montréal Health Center, Montreal, Canada

Reprint requests: Jan Schmitges, M.D., Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, 1058, Rue Street-Denis, Montreal, Quebec Canada H2X 3J4

Résumé

Objective

To examine the homologous blood transfusion (HBT), autologous blood transfusion (ABT) and intraoperative blood conservation technique (IOBCT) rates and trends at open (ORP) and minimally invasive radical prostatectomy (MIRP).

Methods

The Nationwide Inpatient Sample was queried. Multivariable logistic regression models focused on all three transfusion types. Covariables consisted of procedure specific annual hospital caseload (AHC), year of surgery, age, Charlson Comorbidity Index, and region.

Results

Overall, 119,966 patients underwent radical prostatectomy between 1998 and 2007. The HBT, ABT, and IOBCT rates were 6.2%, 6.0%, and 1.2%, respectively. HBT rates ranged from 5.1-5.1% between 1998 and 2007 (P = .49) vs 9.4-2.7% (P < .001) for ABT vs 1.9-0.9% (P = .003) for IOBCT in the same time period, respectively. In multivariable analyses, ORP patients treated at intermediate (odds ratio [OR] 1.48, P = .003) and low (OR 2.73, P < .001) AHC institutions were more likely to receive an HBT than ORP patients treated at high AHC institutions. Conversely, MIRP patients treated at high (OR 0.46, P = .040), intermediate (OR 0.27, P = .001), and low (OR 0.59, P = .015) AHC institutions were less likely to receive an HBT than ORP patients treated at high AHC institutions.

Conclusion

Our results indicate that the overall transfusion rate at radical prostatectomy decreased within the last decade because of a substantial decline in ABT use. Moreover, MIRP protects from HBT, even when performed at low AHC Centers.

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