Is There An Optimal Trade-Off Between Anaemia And Red Blood Cell Transfusion In Surgical Critically Ill Patients After Oncologic Surgery?

Background and objectives Equipoise remains on the optimal transfusion strategy in surgical oncologic patients. The primary objective of our study was to determine the impact of anaemia and red blood cells (RBCs) transfusion on severe postoperative complications in surgical oncologic critically ill patients.Materials and methods Retrospective single-centre study. Adults admitted to intensive care unit after major oncologic surgery were eligible. Analyses to determine the independent risk factors, including anaemia or RBC transfusion, for postoperative complications and/or hospital mortality were performed.Results Of the 283 patients included, 246 patients (86.9%) had anaemia. Fifty-five patients (19 center dot 4%) were transfused. Patients exposed to moderate-to-severe anaemia or RBC transfusion had more often severe complications, especially acute kidney injury and infectious complications. Multivariate analysis found an independent association between moderate and severe anaemia and severe postoperative complications (moderate anaemia: OR 14 center dot 02 [2 center dot 52-264]; severe anaemia: OR 16 center dot 25 [2 center dot 62-318 center dot 5]; P < 0 center dot 05). Elderly, obese patients and patients operated from abdominal surgery appeared to be more vulnerable to anaemia than other patients. Transfusion was also an independent risk factor for postoperative complications (OR 4 center dot 19 [2 center dot 12-8 center dot 39]; P < 0 center dot 001). When considering moderate-to-severe anaemic patients, RBC transfusion was no longer associated with postoperative complications.Conclusions Anaemia was associated with severe postoperative complications, and this association was stronger in elderly, obese patients and after abdominal surgery. RBC transfusion also negatively impacts on patients' prognosis. However, this association was not found in case of moderate-to-severe anaemia exposure (haemoglobin < 10 g/dl).