Changes in perioperative red cell transfusion practice over time in patients undergoing surgery for upper gastrointestinal and liver cancer: a retrospective cohort study at a single tertiary centre

OBJECTIVES: Optimum transfusion trigger for adults undergoing cancer surgery is uncertain. Published guidelines recommend restrictive transfusion strategies in hospitalised adults. We aimed to measure the red cell transfusion rate and haemoglobin trigger in patients undergoing cancer surgery and how closely practice reflected published guidelines. DESIGN: Retrospective cohort study. SETTING: Single tertiary centre. PARTICIPANTS: Adult patients undergoing surgery for upper gastrointestinal or liver malignancy. EXPOSURE: Postguideline change (2015–2017) versus preguideline change (2011–2012). OUTCOME MEASURES: Primary: transfusion rate, secondary: transfusion trigger. Multivariable logistic regression was used to assess factors and adjust for confounders affecting our outcome measures. RESULTS: 1578 surgical records were identified for 1520 patients. 946/1530 (62%) patients had preoperative anaemia. The transfusion rate decreased from 23% in 2011–2012 to 14% in 2015–2017. This change remained significant after adjusting for other variables associated with transfusion rates. Mean pretransfusion haemoglobin in those who were transfused was 78±13 g/L in 2011–2012 and 80±15 g/L in 2015–2017. This change in haemoglobin transfusion triggers was not significant. CONCLUSION: Transfusion rate has decreased over the study period in patients undergoing surgery for malignancy and is consistent with a restrictive transfusion strategy.