Risk Factors and Complications of Transfusion Following Partial Nephrectomy

Background and objectives Partial nephrectomy (PN) is the gold standard for small renal tumors, preserving nephrons without compromising oncologic outcomes. However, PN carries a higher complication rate, with postoperative bleeding being a notable risk. Despite its significance, data on transfusion risk factors remain limited. This study identifies variables associated with perioperative transfusion in patients undergoing PN. Methods A retrospective cohort study was conducted using the 2019-2020 American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. Patients undergoing PN were identified and stratified by transfusion status. Preoperative, perioperative, and postoperative variables were analyzed using univariate and multivariate logistic regression models. Results Among 892 PN patients, 116 (13.0%) required transfusion. Transfused patients were older (p=0.026) and had higher rates of disseminated cancer (p=0.020), weight loss (p=0.036), bleeding disorders (p=0.025), and prior pelvic surgeries (p=0.014). Perioperative factors included longer operative times (p<0.001), concomitant procedures (p<0.001), and unplanned reoperations (p<0.001). Multivariate analysis identified concomitant procedures (OR: 2.27, p<0.001), prior chemotherapy (OR: 4.89, p=0.001), and unplanned reoperation (OR: 6.16, p<0.001) as significant predictors. Transfusion increased the odds of composite complications (OR: 1.20, p=0.041). Conclusions Preoperative and perioperative factors influence transfusion risk, which in turn increases complication rates. Careful preoperative assessment and surgical planning can minimize transfusion-related morbidity. Restrictive transfusion strategies and optimized patient selection may improve outcomes.