Postoperative transfusion hemoglobin threshold and functional recovery after high-risk oncologic surgery: A randomized controlled pilot study

Xavier Chapalain, Sigismond Lasocki, Thomas Gargadennec, Maëlys Consigny, Maeva Campfort, Anna Cadic, Maxime Léger, Patricia Dias, Catherine Le Niger, Rosemary L. Sparrow, Olivier Huet, Cécile Aubron

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Robust evidence to inform best transfusion management after major oncologic surgery, where postoperative recovery might impact treatment regimens for cancer, is lacking. We conducted a study to validate the feasibility of a larger trial comparing liberal versus restrictive red blood cells (RBC) transfusion strategies after major oncologic surgery. Study Design and Methods: This was a two-center, randomized, controlled, study of patients admitted to the intensive care unit after major oncologic surgery. Patients whose hemoglobin level dropped below 9.5 g/dL, were randomly assigned to immediately receive a 1-unit RBC transfusion (liberal) or delayed until the hemoglobin level dropped below 7.5 g/dL (restrictive). The primary outcome was the median hemoglobin level between randomization to day 30 post-surgery. Disability-free survival was evaluated by the WHODAS 2.0 questionnaire. Results: 30 patients were randomized (15 patients/group) in 15 months with a mean recruitment rate of 1.8 patients per month. The median hemoglobin level was significantly higher in the liberal group than in the restrictive group: 10.1 g/dL (IQR 9.6–10.5) versus 8.8 g/dL (IQR 8.3–9.4), p <.001, and RBC transfusion rates were 100% versus 66.7%, p =.04. The disability-free survival was similar between groups: 26.7% versus 20%, p = 1. Discussion: Our results support the feasibility of a phase 3 randomized controlled trial comparing the impact of liberal versus restrictive transfusion strategies on the functional recovery of critically ill patients following major oncologic surgery.

Original languageEnglish
Pages (from-to)1129-1140
Number of pages12
JournalTransfusion
Volume63
Issue number6
DOIs
Publication statusPublished - Jun 2023

Keywords

  • critically ill patients
  • functional recovery
  • hemoglobin threshold
  • oncologic surgery
  • pilot study
  • red blood cells transfusion

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