Intraoperative blood transfusion ups VTE risk after radical cystectomy

Intraoperative blood transfusion appears to increase the risk of venous thromboembolism (VTE) within 90 days following radical cystectomy among patients with bladder cancer, a study has shown.

Using the Mayo Clinic cystectomy registry, the authors identified patients who underwent radical cystectomy for bladder cancer from 1980 to 2020. They analysed blood transfusion during the initial postoperative hospitalization as a three-tiered variable: no transfusion, postoperative transfusion alone, or intraoperative with or without postoperative transfusion.

Multivariable logistic regression was used to explore the associations between clinicopathological variables and 90-day VTE, the primary outcome, with transfusion analysed as both a categorical and a continuous variable.

Of the 3,755 radical cystectomy patients identified, 162 (4.3 percent) had VTE within 90 days of radical cystectomy. More than half (56 percent) received a median of 1 unit of blood transfusion, including 811 (38 percent) with intraoperative transfusion only, 572 (27 percent) with postoperative transfusion only, and 729 (35 percent) with intraoperative and postoperative transfusion.

Multivariable analysis revealed a significantly elevated risk of VTE (adjusted odds ratio [aOR], 1.73, 95 percent confidence interval [CI], 1.17‒2.56; p=0.002) in patients who had intraoperative with or without postoperative blood transfusion.

When analysed as a continuous variable, each unit of blood transfused intraoperatively correlated with a 7-percent increased likelihood of VTE (aOR, 1.07, 95 percent CI, 1.01‒1.13; p=0.03).

“To ensure optimal perioperative outcomes, continued effort to limit blood transfusion in radical cystectomy patients is warranted,” the authors said.