Impact of perioperative hemoglobin levels on postoperative outcomes in gastric cancer surgery

Abstract

Background: The aim of this study was to evaluate the association of postoperative blood transfusion and anemia with postoperative outcomes in gastric cancer surgery. Methods: We enrolled 588 patients who had undergone curative resection for gastric cancer. Input variables for risk assessment consisted of 3 categories: patient demographics, surgical and pathological factors, and anemia-related factors. Postoperative outcomes included 30-day morbidity and mortality. Univariate and multivariate analyses were performed to identify risk factors influencing postoperative complications. Results: The rate of total complications was 19.0 %. Comorbidity, lowest hemoglobin (Hb) level from the operative day up to postoperative day 7 (LOW-Hb), the percentage of drop in Hb level on postoperative day 2 (POD2-Hb change), and postoperative transfusion were independent risk factors in the multivariate analysis, with LOW-Hb and postoperative transfusion found to be the most significant factors. When LOW-Hb was ≥9.0 g/dL, postoperative complications were higher in the transfused group than in the non-transfused group (60.0 vs. 14.2 %, respectively, p = 0.024), but when LOW-Hb was <9.0 g/dL, postoperative complications were not different between the 2 groups (44.6 vs. 37.5 %, p = 0.525). Conclusion: The lowest postoperative Hb level and postoperative transfusion were the most significant risk factors for postoperative complications in gastric cancer surgery. © 2012 The International Gastric Cancer Association and The Japanese Gastric Cancer Association.