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The Impact of Perioperative Packed Red Blood Cell Transfusion on Survival in Epithelial Ovarian Cancer
  1. Lindsay L. Morgenstern Warner*,
  2. Sean C. Dowdy, MD,
  3. Janice R. Martin, RN,
  4. Maureen A. Lemens, RN, BSN,
  5. Michaela E. McGree, BS§,
  6. Amy L. Weaver, MS§,
  7. Karl C. Podratz, MD, PhD and
  8. Jamie N. Bakkum-Gamez, MD
  1. *Mayo Medical School,
  2. Department of Obstetrics and Gynecology, Division of Gynecologic Surgery,
  3. Department of Surgical Clinical Research, and
  4. §Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
  1. Address correspondence and reprint requests to Jamie N. Bakkum-Gamez, MD, Eisenberg Lobby 71, Mayo Clinic, 200 First St, SW, Rochester, MN 55905. E-mail: bakkum.jamie{at}


Objective Perioperative packed red blood cell transfusion (PRBCT) has been implicated as a negative prognostic marker in surgical oncology. There is a paucity of evidence on the impact of PRBCT on outcomes in epithelial ovarian cancer (EOC). We assessed whether PRBCT is an independent risk factor of recurrence and death from EOC.

Methods Perioperative patient characteristics and process-of-care variables (defined by the National Surgical Quality Improvement Program) were retrospectively abstracted from 587 women who underwent primary EOC staging between January 2, 2003, and December 29, 2008. Associations with receipt of PRBCT were evaluated using univariate logistic regression models. The associations between receipt of PRBCT and disease-free survival and overall survival were evaluated using multivariable Cox proportional hazards models and using propensity score matching and stratification, respectively.

Results The rate of PRBCT was 77.0%. The mean ± SD units transfused was 4.1 ± 3.1 U. In the univariate analysis, receipt of PRBCT was significantly associated with older age, advanced stage (≥IIIA), undergoing splenectomy, higher surgical complexity, serous histologic diagnosis, greater estimated blood loss, longer operating time, the presence of residual disease, and lower preoperative albumin and hemoglobin. Perioperative packed red blood cell transfusion was not associated with an increased risk for recurrence or death, in an analysis adjusting for other risk factors in a multivariable model or in an analysis using propensity score matching or stratification to control for differences between the patients with and without PRBCT.

Conclusions Perioperative packed red blood cell transfusion does not seem to be directly associated with recurrence and death in EOC. However, lower preoperative hemoglobin was associated with a higher risk for recurrence. The need for PRBCT seems to be a stronger prognostic indicator than the receipt of PRBCT.

  • Perioperative red blood cell transfusion
  • Ovarian cancer
  • Disease-free survival
  • Overall survival

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  • Funded in part by the Office of Women’s Health Research Building Interdisciplinary Careers in Women’s Health (BIRCWH award K12 HD065987). The funding sources played no role in the design, conduct, or reporting of this study. The funding source provided protected research time for Dr Bakkum-Gamez.

  • The authors declare no conflicts of interest.