Transfusion Requirements in Surgical Oncology Patients---A Prospective, Randomized Controlled Trial
ABSTRACT
Background: Several studies have indicated that a restrictive erythrocyte transfusion strategy is as safe as a liberal one in critically ill
patients, but there is no clear evidence to support the superiority of any perioperative transfusion strategy in patients with cancer.
Methods: In a randomized, controlled, parallel-group, double-blind (patients and outcome assessors) superiority trial in the intensive
care unit of a tertiary oncology hospital, the authors evaluated whether a restrictive strategy of erythrocyte transfusion (transfusion
when hemoglobin concentration <7 g/dl) was superior to a liberal one (transfusion when hemoglobin concentration <9 g/dl) for
reducing mortality and severe clinical complications among patients having major cancer surgery. All adult patients with cancer having
major abdominal surgery who required postoperative intensive care were included and randomly allocated to treatment with the
liberal or the restrictive erythrocyte transfusion strategy. The primary outcome was a composite endpoint of mortality and morbidity.
Results: A total of 198 patients were included as follows: 101 in the restrictive group and 97 in the liberal group. The primary composite
endpoint occurred in 19.6% (95% CI, 12.9 to 28.6%) of patients in the liberal-strategy group and in 35.6% (27.0 to 45.4%) of patients
in the restrictive-strategy group (P = 0.012). Compared with the restrictive strategy, the liberal transfusion strategy was associated with an
absolute risk reduction for the composite outcome of 16% (3.8 to 28.2%) and a number needed to treat of 6.2 (3.5 to 26.5).
Conclusion: A liberal erythrocyte transfusion strategy with a hemoglobin trigger of 9 g/dl was associated with fewer major
postoperative complications in patients having major cancer surgery compared with a restrictive strategy. (Anesthesiology
2015; 122:29-38)