Restrictive transfusion in radical cystectomy is safe

Area of Science:

• Urology
• Oncology
• Transfusion Medicine

Background:

• Perioperative blood transfusion (PBT) is common in radical cystectomy (RC) but linked to worse oncologic outcomes.
• The safety and efficacy of limiting PBT in elderly and comorbid RC patients remain understudied.

Purpose of the Study:

• To investigate the safety of a restrictive transfusion protocol (RTP) in RC patients.
• To compare oncologic outcomes between patients who received PBT and those who did not.

Main Methods:

• Analysis of 173 consecutive RC patients treated with RTP.
• Pairwise matching to a historical cohort with liberal PBT for 90-day outcome comparison.
• Multivariable analysis to identify predictors of PBT and its association with survival.

Main Results:

• RTP was safe, with no significant differences in 90-day complications, mortality, or readmissions compared to liberal transfusion.
• Patients receiving PBT had higher estimated blood loss and lower baseline hematocrit.
• Perioperative blood transfusion (PBT) was independently associated with lower recurrence-free survival and overall survival.

Conclusions:

• A restrictive transfusion protocol (RTP) is safe for patients undergoing radical cystectomy (RC).
• Limiting perioperative blood transfusions (PBT) in RC is associated with improved oncologic outcomes, including recurrence-free and overall survival.