Risk factors and outcomes of intraoperative blood transfusion in elderly patients undergoing gastrointestinal cancer surgery

BACKGROUND There is an ongoing debate regarding the relationship between intraoperative blood transfusions and patient outcomes. Unifying the results is difficult because of differences in surgery type, target population and postoperative observation indicators. AIM To evaluate the risk factors for intraoperative blood transfusion and its impact on postoperative outcomes in elderly gastrointestinal cancer patients. METHODS This was a retrospective single-center study of elderly patients (≥ 65 years old) who underwent elective abdominal surgery for gastrointestinal cancer with general anesthesia. Patients with chronic kidney disease and missing related data were excluded. The primary outcomes included acute kidney injury (AKI), myocardial injury, and respiratory complications during hospitalization. Multivariate logistic regression was performed to explore the exposure-outcome relationship. RESULTS A total of 967 patients were included in this study. A lower preoperative hematocrit level, longer operative time (> 300 minutes) and greater amount of blood loss were observed in 145 (15.0%) patients who received blood transfusions during surgery (P < 0.0005). Among these patients, the incidences of AKI, myocardial injury and respiratory complications were 8.3% (n = 12), 5.5% (n = 8), and 15.9% (n = 23), respectively, and these values were significantly greater. Multivariate analysis revealed that receiving a transfusion was an independent risk factor for AKI, myocardial injury and respiratory complications (all P < 0.05). CONCLUSION These results demonstrate that intraoperative blood transfusion increases the risk of poorer outcomes in elderly patients receiving gastrointestinal cancer surgery. These findings provide new ideas for improving the prognosis of elderly cancer patients.