Effect of Perioperative Anaemia and Blood Transfusion on Overall Survival in Major Cancer Surgery: A Retrospective Analysis

Background and Aims: Anaemia is prevalent amongst patients undergoing major cancer surgery. The management of anaemia is complex, often necessitating blood transfusion. Blood transfusion has its attendant risks of adversely affecting overall survival following curative cancer surgery. Hence, we aimed to assess the risk of anaemia and blood transfusion individually and in combination on the 3-year overall survival after cancer surgery. Methods: A retrospective analysis of patients who underwent major cancer surgery and assessed their 3-year overall survival rate was conducted. The details of the trend in perioperative haemoglobin (Hb) values were collected from the records. The risk factors for poor survival in patients categorised based on the various combinations of pre-operative anaemia and blood transfusion were analysed. Results: We analysed 1142 patient records. The incidence of pre-operative anaemia was 47.3%. The 3-year overall survival rate for the entire group was 62.8% ( n = 717). The categorywise overall survival rates were 67% ( n = 487) in non-anaemic patients who did not have blood transfusion, 56.2% ( n = 145) in non-anaemic patients who had blood transfusion, 68.6% ( n = 35) in anaemic patients who did not have blood transfusion and 47.2% ( n = 50) in anaemic patients who had blood transfusion ( P < 0.001). The mean difference in Hb between the PAC visit date and the day before surgery is 0.01 ± 0.9 g/dL. In Category 1 and 2 groups, patients who underwent surgery of the bone, spine and soft-tissue tumour had a better survival with a 50% reduction in mortality at 3 years in Category 1 (odds ratio [OR]: 0.503, 95% confidence interval [CI]: 0.264, 0.959, P = 0.037) and 77% reduction in mortality in Category 2 (OR: 0.229, 95% CI: 0.08, 0.7, P = 0.009). Conclusion: Patients with pre-operative anaemia and intraoperative blood transfusion had a lower survival than patients with either anaemia or blood transfusion alone. Patients with anaemia who did not receive a blood transfusion had a similar survival rate to those without anaemia.