Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2025; 17(7): 105860
Published online Jul 27, 2025. doi: 10.4240/wjgs.v17.i7.105860
Risk factors and outcomes of intraoperative blood transfusion in elderly patients undergoing gastrointestinal cancer surgery
Miao-Miao Guo, Chun-Yan Ji, Rong-Rong Gu, Ke Nan, Chang-Hong Miao, Qi-Chao Wu
Miao-Miao Guo, Rong-Rong Gu, Ke Nan, Chang-Hong Miao, Qi-Chao Wu, Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Miao-Miao Guo, Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, Jiangsu Province, China
Chun-Yan Ji, Department of Nutrition, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Co-first authors: Miao-Miao Guo and Chun-Yan Ji.
Co-corresponding authors: Chang-Hong Miao and Qi-Chao Wu.
Author contributions: Guo MM and Ji CY contributed equally to this manuscript as co-first authors. Guo MM conceived and designed the study, analyzed and interpreted the data; Guo MM and Ji CY performed the experiments, collected the data, and wrote the paper; Guo MM, Ji CY, Gu RR, Nan K, Miao CH, and Wu QC reviewed and edited the manuscript; Miao CH and Wu QC gave final approval of the version to be published and they contributed equally to this study as co-corresponding authors. All of the authors read and approved the manuscript.
Supported by the National Natural Science Foundation of China, No. 81901999; the Natural Science Foundation of Shanghai Municipality, No. 23ZR1410900; and Wu Jieping Medical Foundation, No. 320.6750.2024-05-47.
Institutional review board statement: The Institutional Review Board for Clinical Investigations at Nanjing Drum Tower Hospital approved the study and agreed to waive the need for informed consent (approval No. 2017-049-01).
Informed consent statement: The Institutional Review Board agreed to waive the need for informed consent. No additional interventions were performed on the patients during the research process, and data extraction and analysis were based on existing clinical records, therefore there are no additional ethical risks.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Due to ethical limitations, the data that support the findings are not be made public.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qi-Chao Wu, MD, Department of Anesthesiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China. wu-qichao@outlook.com
Received: February 10, 2025
Revised: March 26, 2025
Accepted: May 26, 2025
Published online: July 27, 2025
Processing time: 165 Days and 5.3 Hours
Abstract
BACKGROUND

There is an ongoing debate regarding the relationship between intraoperative blood transfusions and patient outcomes. Unifying the results is difficult because of differences in surgery type, target population and postoperative observation indicators.

AIM

To evaluate the risk factors for intraoperative blood transfusion and its impact on postoperative outcomes in elderly gastrointestinal cancer patients.

METHODS

This was a retrospective single-center study of elderly patients (≥ 65 years old) who underwent elective abdominal surgery for gastrointestinal cancer with general anesthesia. Patients with chronic kidney disease and missing related data were excluded. The primary outcomes included acute kidney injury (AKI), myocardial injury, and respiratory complications during hospitalization. Multivariate logistic regression was performed to explore the exposure-outcome relationship.

RESULTS

A total of 967 patients were included in this study. A lower preoperative hematocrit level, longer operative time (> 300 minutes) and greater amount of blood loss were observed in 145 (15.0%) patients who received blood transfusions during surgery (P < 0.0005). Among these patients, the incidences of AKI, myocardial injury and respiratory complications were 8.3% (n = 12), 5.5% (n = 8), and 15.9% (n = 23), respectively, and these values were significantly greater. Multivariate analysis revealed that receiving a transfusion was an independent risk factor for AKI, myocardial injury and respiratory complications (all P < 0.05).

CONCLUSION

These results demonstrate that intraoperative blood transfusion increases the risk of poorer outcomes in elderly patients receiving gastrointestinal cancer surgery. These findings provide new ideas for improving the prognosis of elderly cancer patients.

Keywords: Blood transfusion; Acute kidney injury; Myocardial injury; Respiratory complications; Elderly patients; Gastrointestinal cancer

Core Tip: This study retrospectively analyzes large - sample clinical data of elderly gastrointestinal tumor patients. By comprehensively analyzing incidences of postoperative complications, it evaluates the impact of intraoperative blood transfusion on the postoperative outcomes of radical resection of major gastrointestinal tumors (surgery duration > 2 hours). The research fills the void of lacking relevant clinical data support for elderly patients in this field. It offers clinical guidance, and provides evidence for transfusion and prognosis management in elderly gastrointestinal tumor patients.