The Association Between Perioperative Red Blood Cell Transfusions and 1-Year Mortality After Major Cancer Surgery: An International Multicenter Observational Study

Cata, JP; Guerra-Londono, JJ; Ramirez, MF; Chen, LL; Warner, MA; Guzman, LFC; Lobo, F; Uribe-Marquez, S; Huang, J; Ruscic, KJ; Chew, STH; Lanigan, M; ARCA-1 Investigators

doi:10.1213/ane.0000000000007236

Perioperative medicine & outcomes

The Association Between Perioperative Red Blood Cell Transfusions and 1-Year Mortality After Major Cancer Surgery: An International Multicenter Observational Study

Anesth AnalgPublished 6 Nov 2024Prospective observational cohort study

Main finding · 1-year all-cause mortalityResultOdds ratio 1.97 95% CI 1.13–3.41

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Authors' conclusion

This international, multicenter observational study showed that perioperative pRBC transfusion was associated with an increased mortality risk.

Study context

Population: Adults with cancer undergoing surgery with curative intent21.1% transfused
Participants: 1,079 adults

Exposure: Perioperative packed red blood cell (pRBC) transfusion vs no transfusion
Outcome: All-cause mortality
Follow-up: 1 year after major cancer surgery

Methodological detailsinternational, multicentre, propensity score matching, multivariable logistic regression

International
Multicentre
Propensity score matching
Multivariable logistic regression

Main finding

1-year all-cause mortality · 1 year

Odds ratio

1.97

95% CI 1.13–3.41

By group

Transfused19.7%

Nontransfused6.5%

Transfused vs Nontransfused

OR 1.97 (95% CI 1.13–3.41)

As reported in the abstract

Observational data: associations, not effects.

Secondary outcomes

Outcome		Estimate
1-year cancer mortality	0.20.5125	OR 1.82 (95% CI 0.97–3.43)
Overall survival	0.20.5125	HR 1.85 (95% CI 1.15–2.99), event not clearly stated
	0.20.5125Ratio (log scale)

30-day postoperative mortality, before propensity score matching

P = 0.0009

Transfused3.5%

Nontransfused0.7%

30-day postoperative mortality, after propensity score matching · propensity score matched

P = 0.34

Transfused4.2%

Nontransfused1.8%

Overall survival: effect of transfusion on overall survival reported as significant

Perioperative pRBC transfusion rate

Rate of perioperative pRBC transfusions: 21.1%

Original publication

The Association Between Perioperative Red Blood Cell Transfusions and 1-Year Mortality After Major Cancer Surgery: An International Multicenter Observational Study. Anesth Analg. Published 6 November 2024. doi:10.1213/ane.0000000000007236

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