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Abstract
Introduction/Background Patients with advanced ovarian cancer (AOC) undergoing surgery are at high risk of receiving blood transfusions (BT). Both anemia and BT are associated with increased morbidity. However, the impact of restrictive BT strategies is under debate. The aim of the study was to evaluate patients’ recovery process and complications after patient blood management (PBM) implementation.
Methodology This retrospective cohort study included 354 patients with AOC undergoing primary and interval debulking surgery at the department of gynecology at Skane University Hospital Lund Sweden, between January 1, 2016 and December 31, 2021. The gradual implementation of PBM guidelines included restrictive BT, tranexamic acid as standard medication before laparotomies and intravenous iron to patients with iron deficiency, with or without anaemia. Severe complication was defined as Clavien Dindo (CD) grade >2. Logistic and linear regression analyses were used to evaluate the difference between the three consecutive periods (2016–2017, 2018–2019, 2020–2021).
Results After implementation of new guidelines, 52% of the patients had at least one transfusion compared to 83% at the baseline, p <0.001. There was no difference in the rate of severe complications (CD > 2) between the groups, adjusted Odds Ratio 0.55 (95%CI 0.26–1.17). Mean haemoglobin level before chemotherapy decreased from 118.9 g/L baseline to 115.2 g/L, p 0.005. The mean difference was -1.32g/L (95%CI -3.04 to -0.22) when adjusted for blood loss and days from surgery to chemotherapy. Length of hospital stay (LHS) decreased from 8.5 days to 7.5 days, p 0.002.
Conclusion BT were reduced by 31%. Despite a slight increase in rate of anaemia after implementation of PBM, severe complications (CD > 2) remained stable. LHS was reduced and chemotherapy was given without delay, indicating that PBM is feasible and without major severe effects on the short recovery and postoperative chemotherapy.
Disclosures Grants from Pharmacosmos, they were not involved in the planning of the study, conduct of the study and interpretation of data.
