Login to Access Video or Poster Abstract: MP22-19
Sources of Funding: None

Introduction

Allogeneic blood transfusions (ABT) may have an immunosuppressive effect on patients via transfusion-related immunomodulation, particularly in patients undergoing cancer surgery. Prior studies have demonstrated strong causality data among patients with colorectal, lung, and hepatobiliary cancers, however the existing data remains mixed in renal malignancies. We examined whether ABT’s increase the risk of mortality and complications (including perioperative infections) after open and minimally invasive nephroureterectomy.

Methods

We used the National Surgical Quality Improvement Program (2010 to 2013) to study the use of ABT as well as identify the rate of post-operative mortality and complications. Subgroup analysis of infectious complications assessed surgical site infection, pneumonia, abscess, urinary tract infection, and sepsis. We examined the association between ABT and mortality, any perioperative complications, and infectious complications after controlling for potential confounders (ASA status, age, race, diabetes, and operative time).

Results

We identified 1,691 nephroureterectomies (534 open, 1157 minimally invasive) performed during the study period. The rate of ABT was 23.6% for open and 8.64% for minimally invasive (13.4% overall). Patients who received an ABT had an increased risk of mortality (5.39% vs 1.09%, p < 0.001), any perioperative complication (30.53% vs 9.97%, p < 0.001), and infectious complications (13.72% vs 4.64%, p < 0.001). After adjusting for potential confounders, ABT remained an independent predictor for all complications, infectious complications, and mortality (p < 0.001).

Conclusions

This analysis supports the concept that ABTs are independently associated with an increased risk of perioperative complications, particularly infectious ones. Urologists should use evidence-based “restrictive� transfusion thresholds to minimize perioperative morbidity and mortality ABTs when performing nephroureterectomy.

Funding

None