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An In Vivo Mouse Model of Total Intravenous Anesthesia During Cancer Resection Surgery
Published on: June 8, 2021
Evaluating variability in use of intravenous albumin in patients undergoing surgery for cancer
Jane Yang1, Tharsiya Martin1, Victor Mak1
1From the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ont. (Yang); Ontario Health (Cancer Care Ontario), Toronto, Ont. (Martin, Mak, Rashid, Hunter, Wright); Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ont. (Zhang, Callum); the Department of Anesthesia, University of Toronto, Toronto, Ont. (Bartoszko); the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ont. (Bartoszko, Zuckerman); the Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Zuckerman); the Department of Surgery, University of Toronto, Toronto, Ont. (Hallet, Wright); the Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Hallet, Wright); the Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ont. (Callum); the Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre, Kingston, Ont. (Callum); the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ont. (Callum).
Background:
Despite numerous randomized controlled trials finding that albumin is not associated with improved patient outcomes, transfusion practice is highly variable. We examined the variability and impact of albumin transfusion on outcomes in cancer surgery.
Methods:
We included consecutive adults undergoing cancer surgery between 2018 and 2021 in Ontario, Canada. The primary exposure was the proportion of patients who received perioperative albumin. The secondary outcomes were hospital length of stay and the incidence of infection, anemia, venous thromboembolism, and mortality in albumin-treated versus non-albumin-treated patients in a case-control analysis.
Results:
Of 155 166 cancer surgeries (66.8% female patients, median age 62.9 yr), 2.5% received perioperative albumin. The cancer surgery types with the highest proportion of patients receiving albumin were hepato-pancreato-biliary (24.8%) and colorectal (18.6%). Of 104 facilities, 12.5% had nonrandom outliers for albumin use in at least 1 cancer type (p = 0.0004). Patient outcomes were different in case-control matched cohorts for colorectal and hepato-pancreato-biliary surgeries, including a higher rate of infection, venous thromboembolism, and mortality in patients treated with albumin (cases) than those who were not (controls).
Conclusion:
Albumin transfusion rates were highly variable among hospitals for the same cancer type. Quality improvement initiatives are warranted to curtail unnecessary albumin transfusions in the perioperative period.
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