Postoperative transfusion hemoglobin threshold and functional recovery after high-risk oncologic surgery: A...

Area of Science:

• Transfusion Medicine
• Oncologic Surgery
• Critical Care

Background:

• Limited evidence exists for optimal red blood cell (RBC) transfusion management post-major oncologic surgery.
• Postoperative recovery can influence cancer treatment regimens, highlighting the need for transfusion strategy research.
• This study aimed to assess the feasibility of a larger trial comparing transfusion approaches.

Purpose of the Study:

• To validate the feasibility of a Phase 3 randomized controlled trial (RCT).
• To compare liberal versus restrictive RBC transfusion strategies after major oncologic surgery.
• To evaluate the impact on functional recovery in critically ill patients.

Main Methods:

• A two-center, randomized controlled study involving intensive care unit patients post-major oncologic surgery.
• Liberal group: 1-unit RBC transfusion for hemoglobin < 9.5 g/dL.
• Restrictive group: delayed transfusion for hemoglobin < 7.5 g/dL.
• Primary outcome: median hemoglobin level (randomization to Day 30).
• Secondary outcome: disability-free survival assessed via WHODAS 2.0.

Main Results:

• 30 patients randomized (15 per group) over 15 months; recruitment rate 1.8 patients/month.
• Median hemoglobin significantly higher in the liberal group (10.1 g/dL) vs. restrictive (8.8 g/dL), p < .001.
• RBC transfusion rates: 100% (liberal) vs. 66.7% (restrictive), p = .04.
• Disability-free survival was similar between groups (26.7% vs. 20%, p = 1).

Conclusions:

• The study supports the feasibility of a larger Phase 3 RCT comparing transfusion strategies.
• Liberal RBC transfusion leads to higher hemoglobin levels post-oncologic surgery.
• Functional recovery (disability-free survival) appears similar between liberal and restrictive strategies in this cohort.