Infectious complications in transfused patients after radical cystectomy

Jen Jane Liu, Patrick Mullane, Max Kates, Nilay Gandhi, Mark P. Schoenberg, Charles Drake, Noah M. Hahn, Steve Frank, Trinity J. Bivalacqua

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Introduction: Infectious complications are common after radical cystectomy (RC), and allogeneic blood transfusions may increase infection risk by an immunosuppressive effect. While it has been suggested that perioperative blood transfusion (PBT) may be associated with adverse oncologic outcomes after RC, no large analyses have assessed whether PBT increases the risk of perioperative infection after RC. Materials and methods: We used the Nationwide Inpatient Sample (1998 to 2011) to study the rate of PBT during RC for bladder cancer and identify infectious complications. We compared rates of infectious complications in patients who did and did not receive PBT and developed a multivariable model to assess the independent risk of infectious complication associated with PBT controlling for age, year of surgery, obesity, chronic kidney disease, comorbidity score, and type of urinary diversion. Results: We identified 126,454 RCs performed during the study period. A total of 34,203 (27%) received a PBT. The use of PBT increased over the study period, from 18.4% in 1998 to 31.6% in 2011 (p < 0.0001). Patients who received a PBT had an increased risk of perioperative infectious complications [36.7% versus 27.7%, unadjusted OR (95% CI) = 1.51 (1.43-1.60), p < 0.0001]. After adjusting for potential confounders, PBT remained an independent predictor of infectious complications [adjusted OR (95% CI) = 1.46 (1.38-1.55), p < 0.0001]. Conclusions: This analysis provides strong observational evidence that PBT is associated with an increased risk of perioperative infectious complications, which may be secondary to transfusion-related immunomodulation. Urologists should aggressively pursue blood conservation strategies and adhere to evidence-based restrictive transfusion thresholds, particularly given the rising rate of PBT.

Original languageEnglish (US)
Pages (from-to)8342-8347
Number of pages6
JournalCanadian Journal of Urology
Volume23
Issue number4
StatePublished - 2016

Fingerprint

Cystectomy
Blood Transfusion
Bloodless Medical and Surgical Procedures
Urinary Diversion
Immunomodulation
Immunosuppressive Agents
Infection
Chronic Renal Insufficiency
Urinary Bladder Neoplasms
Comorbidity
Inpatients
Obesity

Keywords

  • Blood transfusion
  • Infectious complication
  • Radical cystectomy

ASJC Scopus subject areas

  • Medicine(all)
  • Urology

Cite this

Liu, J. J., Mullane, P., Kates, M., Gandhi, N., Schoenberg, M. P., Drake, C., ... Bivalacqua, T. J. (2016). Infectious complications in transfused patients after radical cystectomy. Canadian Journal of Urology, 23(4), 8342-8347.

Infectious complications in transfused patients after radical cystectomy. / Liu, Jen Jane; Mullane, Patrick; Kates, Max; Gandhi, Nilay; Schoenberg, Mark P.; Drake, Charles; Hahn, Noah M.; Frank, Steve; Bivalacqua, Trinity J.

In: Canadian Journal of Urology, Vol. 23, No. 4, 2016, p. 8342-8347.

Research output: Contribution to journalArticle

Liu, JJ, Mullane, P, Kates, M, Gandhi, N, Schoenberg, MP, Drake, C, Hahn, NM, Frank, S & Bivalacqua, TJ 2016, 'Infectious complications in transfused patients after radical cystectomy', Canadian Journal of Urology, vol. 23, no. 4, pp. 8342-8347.
Liu JJ, Mullane P, Kates M, Gandhi N, Schoenberg MP, Drake C et al. Infectious complications in transfused patients after radical cystectomy. Canadian Journal of Urology. 2016;23(4):8342-8347.
Liu, Jen Jane ; Mullane, Patrick ; Kates, Max ; Gandhi, Nilay ; Schoenberg, Mark P. ; Drake, Charles ; Hahn, Noah M. ; Frank, Steve ; Bivalacqua, Trinity J. / Infectious complications in transfused patients after radical cystectomy. In: Canadian Journal of Urology. 2016 ; Vol. 23, No. 4. pp. 8342-8347.
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abstract = "Introduction: Infectious complications are common after radical cystectomy (RC), and allogeneic blood transfusions may increase infection risk by an immunosuppressive effect. While it has been suggested that perioperative blood transfusion (PBT) may be associated with adverse oncologic outcomes after RC, no large analyses have assessed whether PBT increases the risk of perioperative infection after RC. Materials and methods: We used the Nationwide Inpatient Sample (1998 to 2011) to study the rate of PBT during RC for bladder cancer and identify infectious complications. We compared rates of infectious complications in patients who did and did not receive PBT and developed a multivariable model to assess the independent risk of infectious complication associated with PBT controlling for age, year of surgery, obesity, chronic kidney disease, comorbidity score, and type of urinary diversion. Results: We identified 126,454 RCs performed during the study period. A total of 34,203 (27{\%}) received a PBT. The use of PBT increased over the study period, from 18.4{\%} in 1998 to 31.6{\%} in 2011 (p < 0.0001). Patients who received a PBT had an increased risk of perioperative infectious complications [36.7{\%} versus 27.7{\%}, unadjusted OR (95{\%} CI) = 1.51 (1.43-1.60), p < 0.0001]. After adjusting for potential confounders, PBT remained an independent predictor of infectious complications [adjusted OR (95{\%} CI) = 1.46 (1.38-1.55), p < 0.0001]. Conclusions: This analysis provides strong observational evidence that PBT is associated with an increased risk of perioperative infectious complications, which may be secondary to transfusion-related immunomodulation. Urologists should aggressively pursue blood conservation strategies and adhere to evidence-based restrictive transfusion thresholds, particularly given the rising rate of PBT.",
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AU - Liu, Jen Jane

AU - Mullane, Patrick

AU - Kates, Max

AU - Gandhi, Nilay

AU - Schoenberg, Mark P.

AU - Drake, Charles

AU - Hahn, Noah M.

AU - Frank, Steve

AU - Bivalacqua, Trinity J.

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N2 - Introduction: Infectious complications are common after radical cystectomy (RC), and allogeneic blood transfusions may increase infection risk by an immunosuppressive effect. While it has been suggested that perioperative blood transfusion (PBT) may be associated with adverse oncologic outcomes after RC, no large analyses have assessed whether PBT increases the risk of perioperative infection after RC. Materials and methods: We used the Nationwide Inpatient Sample (1998 to 2011) to study the rate of PBT during RC for bladder cancer and identify infectious complications. We compared rates of infectious complications in patients who did and did not receive PBT and developed a multivariable model to assess the independent risk of infectious complication associated with PBT controlling for age, year of surgery, obesity, chronic kidney disease, comorbidity score, and type of urinary diversion. Results: We identified 126,454 RCs performed during the study period. A total of 34,203 (27%) received a PBT. The use of PBT increased over the study period, from 18.4% in 1998 to 31.6% in 2011 (p < 0.0001). Patients who received a PBT had an increased risk of perioperative infectious complications [36.7% versus 27.7%, unadjusted OR (95% CI) = 1.51 (1.43-1.60), p < 0.0001]. After adjusting for potential confounders, PBT remained an independent predictor of infectious complications [adjusted OR (95% CI) = 1.46 (1.38-1.55), p < 0.0001]. Conclusions: This analysis provides strong observational evidence that PBT is associated with an increased risk of perioperative infectious complications, which may be secondary to transfusion-related immunomodulation. Urologists should aggressively pursue blood conservation strategies and adhere to evidence-based restrictive transfusion thresholds, particularly given the rising rate of PBT.

AB - Introduction: Infectious complications are common after radical cystectomy (RC), and allogeneic blood transfusions may increase infection risk by an immunosuppressive effect. While it has been suggested that perioperative blood transfusion (PBT) may be associated with adverse oncologic outcomes after RC, no large analyses have assessed whether PBT increases the risk of perioperative infection after RC. Materials and methods: We used the Nationwide Inpatient Sample (1998 to 2011) to study the rate of PBT during RC for bladder cancer and identify infectious complications. We compared rates of infectious complications in patients who did and did not receive PBT and developed a multivariable model to assess the independent risk of infectious complication associated with PBT controlling for age, year of surgery, obesity, chronic kidney disease, comorbidity score, and type of urinary diversion. Results: We identified 126,454 RCs performed during the study period. A total of 34,203 (27%) received a PBT. The use of PBT increased over the study period, from 18.4% in 1998 to 31.6% in 2011 (p < 0.0001). Patients who received a PBT had an increased risk of perioperative infectious complications [36.7% versus 27.7%, unadjusted OR (95% CI) = 1.51 (1.43-1.60), p < 0.0001]. After adjusting for potential confounders, PBT remained an independent predictor of infectious complications [adjusted OR (95% CI) = 1.46 (1.38-1.55), p < 0.0001]. Conclusions: This analysis provides strong observational evidence that PBT is associated with an increased risk of perioperative infectious complications, which may be secondary to transfusion-related immunomodulation. Urologists should aggressively pursue blood conservation strategies and adhere to evidence-based restrictive transfusion thresholds, particularly given the rising rate of PBT.

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