Introduction
Methods
Design and patients
Surgical procedures and peri-operative management
Definition of BTF
Definition of post-operative infections
Data collection
Matching
Statistical analysis
Results
Clinicopathological characteristics of the patients
Variables | Transfusion group (n = 426) | Non-transfusion group (n = 1638) | P value |
---|---|---|---|
Gender (males) | 267 (62.3%) | 1,096 (66.9%) | 0.100 |
Age (years) | 57.91 ± 11.17 | 54.72 ± 10.24 | < 0.001 |
Body Mass Index (kg/m2) | 21.95 ± 3.01 | 21.24 ± 2.78 | < 0.001 |
ASA score | < 0.001 | ||
1 | 53 (12.4%) | 261 (15.9%) | |
2 | 286 (67.1%) | 1224 (74.7%) | |
3 | 83 (19.5%) | 147 (9.0%) | |
4 | 4 (0.9%) | 6 (0.4%) | |
Smoking history | 164 (38.5%) | 717 (43.8%) | 0.050 |
Any comorbidities | 145 (34.0%) | 477 (29.1%) | 0.049 |
History of abdominal surgery | 49 (11.5%) | 163 (10.0%) | 0.347 |
Neo-adjuvant chemotherapy | 27 (6.3%) | 98 (6.0%) | 0.784 |
Pre-operative white blood cell count (× 109/L) | 5.90 ± 2.00 | 6.21 ± 1.83 | 0.002 |
Pre-operative lymphocyte count (× 109/L) | 1.56 ± 0.77 | 1.86 ± 0.64 | < 0.001 |
Pre-operative albumin (g/L) | 35.83 ± 4.89 | 38.81 ± 4.28 | < 0.001 |
Pre-operative hemoglobin (g/L) | 89.62 ± 24.11 | 126.23 ± 18.26 | < 0.001 |
Complication due to the tumora | 203 (47.7%) | 252 (15.4%) | < 0.001 |
Operation method | 0.008 | ||
Open | 380 (89.2%) | 1377 (84.1%) | |
Laparoscopy | 46 (10.8%) | 261 (15.9%) | |
Type of resection | < 0.001 | ||
Subtotal gastrectomy | 290 (68.1%) | 1292 (78.9%) | |
Total gastrectomy | 136 (31.9%) | 346 (21.1%) | |
Combined multi-organ resection | 77 (18.1%) | 107 (6.5%) | < 0.001 |
Tumor size (cm) | 4.94 ± 2.11 | 3.89 ± 1.99 | < 0.001 |
Tumor location | < 0.001 | ||
Upper | 53 (12.4%) | 123 (7.5%) | |
Middle | 114 (26.8%) | 316 (19.3%) | |
Lower | 237 (55.6%) | 1148 (70.1%) | |
Diffuse | 22 (5.2%) | 51 (3.1%) | |
pTNM stageb | < 0.001 | ||
I | 57 (13.4%) | 471 (28.8%) | |
II | 66 (15.5%) | 368 (22.5%) | |
III | 303 (71.1%) | 799 (48.8%) | |
Intra-operative blood loss (mL) | 261 ± 200 | 190 ± 83 | < 0.001 |
Operation time (min) | 215.75 ± 62.13 | 196.22 ± 50.87 | < 0.001 |
Post-operative complications classification | < 0.001 | ||
None | 353 (82.9%) | 1,529 (93.3%) | |
Infectious complications | 51 (12.0%) | 78 (4.8%) | |
Non-infectious complications | 22 (5.2%) | 31 (1.9%) | |
Post-operative complications severityc | < 0.001 | ||
None | 353 (82.9%) | 1529 (93.3%) | |
Grade II | 45 (10.6%) | 80 (4.9%) | |
Grade III or greater | 28 (6.6%) | 29 (1.8%) | |
Transferring to ICU post-operation | 22 (5.2%) | 27 (1.6%) | < 0.001 |
Post-operative hospital stays (days) | 13.47 ± 11.87 | 11.37 ± 3.70 | < 0.001 |
Post-operative complications
Complications | Number (%) |
---|---|
Infectious | 139 (63.2%) |
Intra-abdominal infection | 74 (33.6%) |
Pneumonia | 39 (17.7%) |
Sepsis not specified | 15 (6.8%) |
Wound infection | 9 (4.1%) |
Urinary tract infection | 2 (0.9%) |
Non-infectious | 81 (36.8%) |
Intestinal obstruction | 15 (6.8%) |
Pleural effusion | 12 (5.5%) |
Ascites | 11 (5.0%) |
Intra-abdominal bleeding | 10 (4.5%) |
Lymphatic fistula | 7 (3.2%) |
Gastrointestinal bleeding | 7 (3.2%) |
Duodenal stump fistula | 3 (1.4%) |
Cerebral infarction | 3 (1.4%) |
Delayed gastric emptying | 2 (0.9%) |
Anastomotic stricture | 2 (0.9%) |
Liver failure | 2 (0.9%) |
Pneumothorax | 2 (0.9%) |
Cardiac arrest | 2 (0.9%) |
Diabetic ketoacidosis | 1 (0.5%) |
Urinary retention | 1 (0.5%) |
Renal failure | 1 (0.5%) |
Propensity score matching analysis
Variables | Transfusion group (n = 361) | Non-transfusion group (n = 361) | P value |
---|---|---|---|
Gender (males) | 225 (62.3%) | 229 (63.4%) | 0.758 |
Age (years) | 57.15 ± 10.92 | 55.76 ± 11.43 | 0.096 |
Body Mass Index (kg/m2) | 21.26 ± 2.74 | 21.24 ± 2.77 | 0.895 |
ASA score | 0.067 | ||
1 | 48 (13.3%) | 46 (12.7%) | |
2 | 256 (70.9%) | 233 (64.5%) | |
3 | 54 (15.0%) | 77 (21.3%) | |
4 | 3 (0.8%) | 5 (1.4%) | |
Smoking history | 136 (37.7%) | 125 (34.6%) | 0.394 |
Any comorbidities | 115 (31.9%) | 119 (33.0%) | 0.750 |
History of abdominal surgery | 40 (11.1%) | 37 (10.2%) | 0.718 |
Neo-adjuvant chemotherapy | 26 (7.2%) | 16 (4.4%) | 0.112 |
Pre-operative white blood cell count (× 109/L) | 5.86 ± 1.87 | 6.10 ± 1.73 | 0.080 |
Pre-operative lymphocyte count (× 109/L) | 1.62 ± 0.74 | 1.66 ± 0.65 | 0.416 |
Pre-operative albumin (g/L) | 36.39 ± 4.87 | 36.91 ± 4.96 | 0.154 |
Pre-operative hemoglobin (g/L) | 91.19 ± 23.99 | 119.98 ± 17.38 | < 0.001 |
Complication due to the tumora | 147 (40.7%) | 147 (40.7%) | 1.000 |
Operation method | 0.091 | ||
Open | 322 (89.2%) | 335 (92.8%) | |
Laparoscopy | 39 (10.8%) | 26 (7.2%) | |
Type of resection | 0.203 | ||
Subtotal gastrectomy | 260 (72.0%) | 275 (76.2%) | |
Total gastrectomy | 101 (28.0%) | 86 (23.8%) | |
Combined multi-organ resection | 52 (14.4%) | 50 (13.9%) | 0.831 |
Tumor size (cm) | 4.77 ± 2.11 | 4.86 ± 2.02 | 0.544 |
Tumor location | 0.441 | ||
Upper | 43 (11.9%) | 40 (11.1%) | |
Middle | 92 (25.5%) | 75 (20.8%) | |
Lower | 210 (58.2%) | 228 (63.2%) | |
Diffuse | 16 (4.4%) | 18 (5.0%) | |
pTNM stageb | 0.977 | ||
I | 55 (15.2%) | 43 (11.9%) | |
II | 58 (16.1%) | 74 (20.5%) | |
III | 248 (68.7%) | 244 (67.6%) | |
Intra-operative blood loss (mL) | 248 ± 177 | 212 ± 90 | 0.001 |
Operation time (min) | 211.78 ± 58.61 | 216.61 ± 45.50 | 0.199 |
Post-operative complication classification | 0.023 | ||
None | 301 (83.4%) | 326 (90.3%) | |
Infectious complications | 43 (11.9%) | 25 (6.9%) | |
Non-infectious complications | 17 (4.7%) | 10 (2.8%) | |
Post-operative complication severityc | 0.006 | ||
None | 301 (83.4%) | 326 (90.3%) | |
Grade II | 38 (10.5%) | 23 (6.4%) | |
Grade III or greater | 22 (6.1%) | 12 (3.3%) | |
Transferring to ICU post-operation | 16 (4.4%) | 11 (3.0%) | 0.327 |
Post-operative hospital stays (days) | 13.20 ± 10.70 | 12.34 ± 4.05 | 0.153 |
Subgroup analysis
Variables | Complications | |
---|---|---|
Transfusion timing | None | Infections |
a. Transfusion timing and infections | ||
Non-BTF group (n = 361) | 336 (93.1%) | 25 (6.9%) |
Pre-operative BTF group (n = 149) | 136 (91.3%) | 13 (8.7%) |
Intra-operative BTF group (n = 128) | 110 (85.9%) | 18 (14.1%) |
Post-operative BTF group (n = 189) | 176 (93.1%) | 13 (6.9%) |
One time-period BTF group (n = 266) | 238 (89.5%) | 28 (10.5%) |
Multi-time-period BTF group (n = 95) | 80 (84.2%) | 15 (15.8%) |
Comparison between subgroups: non-BTF vs. pre-operative BTF, P = 0.482; non-BTF vs. intra-operative BTF, P = 0.014; non-BTF vs. post-operative BTF, P = 0.984; pre-operative BTF vs. intra-operative BTF, P = 0.160; pre-operative BTF vs. post-operative BTF, P = 0.527; intra-operative BTF vs. post-operative BTF, P = 0.035 | ||
Non-BTF vs. one time-period BTF, P = 0.109; non-BTF vs. multi-time-period BTF, P = 0.007; one time-period BTF vs. multi-time-period BTF, P = 0.174 |
Variables | Complications | |
---|---|---|
Transfusion volume | None | Infections |
b. Transfusion volume and infections | ||
Non-BTF group (n = 361) | 336 (93.1%) | 25 (6.9%) |
Low-volume BTF group (n = 74) | 66 (89.2%) | 8 (10.8%) |
Moderate-volume BTF group (n = 228) | 205 (89.9%) | 23 (10.1%) |
High-volume BTF group (n = 59) | 47 (79.7%) | 12 (20.3%) |
Comparison between subgroups: non-BTF vs. low-volume BTF, P = 0.250; non-BTF vs. moderate-volume BTF, P = 0.172; non-BTF vs. high-volume BTF, P = 0.001; low-volume BTF vs. moderate-volume BTF, P = 0.859; low-volume BTF vs. high-volume BTF, P = 0.127; moderate-volume BTF vs. high-volume BTF, P = 0.032 |
Variables | Complications | |
---|---|---|
Transfusion type | None | Infections |
c. Leukocyte depletion and infections | ||
Non-BTF group (n = 361) | 336 (93.1%) | 25 (6.9%) |
Leukocyte-depleted BTF group (n = 221) | 197 (89.1%) | 24 (10.9%) |
Leukocyte-non-depleted BTF group (n = 140) | 121 (86.4%) | 19 (13.6%) |
BTF blood transfusion | ||
Comparison between subgroups: non-BTF vs. leukocyte-depleted BTF, P = 0.097; non-BTF vs. leukocyte-non-depleted BTF, P = 0.018; leukocyte-depleted BTF vs. leukocyte-non-depleted BTF, P = 0.438 |
Univariate and multivariate logistic regression analysis
Variables | Infections (n = 68) | Non-infection (n = 654) | χ2 value | P value |
---|---|---|---|---|
Sex (male: female) | 48/20 | 406/248 | 1.911 | 0.167 |
Age (years) ≥ 65/<65 | 20/48 | 158/496 | 0.915 | 0.339 |
BMI (kg/m2) ≥ 25/<25 | 13/55 | 60/594 | 6.701 | 0.010 |
Smoking history; yes/no | 34/34 | 227/427 | 6.239 | 0.012 |
ASA score ≥ 3/<3 | 16/52 | 123/531 | 0.883 | 0.347 |
Comorbidity; yes/no | 28/40 | 206/448 | 2.634 | 0.105 |
Pre-operative white blood cell count (× 109/L) ≥ 4/<4 | 64/4 | 584/70 | 1.556 | 0.212 |
Pre-operative lymphocyte count (× 109/L) ≥ 1.5/<1.5 | 38/30 | 353/301 | 0.090 | 0.764 |
Pre-operative hemoglobin (g/L) ≥ 100/<100 | 43/25 | 389/265 | 0.361 | 0.548 |
Pre-operative albumin (g/L) ≥ 35/ <35 | 39/29 | 429/225 | 1.836 | 0.175 |
Complication due to the tumora; yes/no | 28/40 | 266/388 | 0.006 | 0.936 |
Neo-adjuvant chemotherapy; yes/no | 4/64 | 38/616 | 0.001 | 0.981 |
Operation method; open/laparoscopy | 7/61 | 58/596 | 0.153 | 0.696 |
Extent of gastric resection; subtotal/total | 48/20 | 487/167 | 0.482 | 0.487 |
Combined multi-organ resection; yes/no | 22/46 | 80/574 | 20.555 | < 0.001 |
Splenectomy; yes/no | 5/63 | 11/643 | 0.141 | 0.002 |
Operation time (min) ≥ 240/< 240 | 36/32 | 183/471 | 18.159 | < 0.001 |
Intra-operative blood loss (mL) ≥ 300/<300 | 26/42 | 191/463 | 2.389 | 0.122 |
Tumor size (cm) ≥ 5/<5 | 39/29 | 343/311 | 0.595 | 0.440 |
Depth of invasion; T4/T1–3 | 55/13 | 489/165 | 1.239 | 0.266 |
Lymph node metastasis; positive/negative | 48/20 | 469/185 | 0.038 | 0.845 |
pTNM stage; III/I–II | 49/19 | 433/221 | 0.950 | 0.330 |
Peri-operative BTF; yes/no | 43/25 | 318/336 | 5.260 | 0.022 |
Variables | Odds ratio (OR) | 95% confidence interval (CI) | P value |
---|---|---|---|
Operation time ≥ 240 min | 2.378 | 1.393–4.062 | 0.002 |
Combined multi-organ resection | 2.418 | 1.281–4.561 | 0.006 |
Peri-operative blood transfusion | 1.872 | 1.094–3.204 | 0.022 |
Body mass index ≥ 25 kg/m2 | 2.149 | 1.074–4.299 | 0.031 |
Smoking history | 1.597 | 0.945–2.699 | 0.080 |
Splenectomy | 1.555 | 0.446–5.418 | 0.480 |