In the United States alone, an estimated 13,960 individuals receive a cervical cancer diagnosis annually, approximately 4,310 of whom succumb to the disease by 2023[15]. Treatment for cervical cancer is primarily determined by the stage of the cancer and often involves a combination of chemoradiation and surgery or surgery alone. However, since 2018, several studies have suggested that minimally invasive surgery (MIS) may be associated with lower disease-free survival (DFS) and overall survival (OS) rates and a greater risk of recurrence than traditional open surgical approaches[3][16]. This has led to the widespread adoption of ARH in recent years. Consequently, increased attention to the issue of perioperative blood transfusion in ARH procedures is warranted.
This study aimed to identify the incidence and determinants of blood transfusion post-ARH. Within the patient cohort, 473 patients (14.84%) received blood transfusions during this period. Notably, blood transfusion rates exhibited a declining trend, decreasing from 18.83% in 2010 to 9.76% in 2019 (Fig. 3). Furthermore, limited research has investigated the predictors of blood transfusion for this patient population[17]. Our comprehensive analysis, spanning the years 2010 to 2019, examines both the economic and healthcare implications of perioperative blood transfusion in ARH patients. We employed logistic regression analysis to explore the associations between hospital characteristics, demographic variables, and the likelihood of receiving a blood transfusion.
As highlighted previously, our study revealed a greater likelihood of blood transfusion among patients of Asian descent, Pacific Islander descent, or Black descent. This may be attributable to the documented high proportion of anemics within these populations[18]. Interestingly, an increased propensity for administering blood transfusions was observed in suburban hospitals located in the northeastern region of the US. This discrepancy might stem from variations in factors such as the level of medical technology, established hospital protocols, and transfusion standards, particularly the criteria used to determine transfusion necessity. Furthermore, patients with private insurance may exhibit a higher socioeconomic status and potentially healthier baseline profiles. This could translate to a lower incidence of conditions such as coagulopathy, chronic blood loss anemia, and nutritional deficiencies, consequently reducing the need for blood transfusions. Additionally, our findings suggest that elderly patients are more susceptible to blood transfusions. This could be due to their reduced tolerance for blood loss and greater burden of cardiovascular comorbidities.
It is now understood that several underlying health conditions significantly increase a patient's need for blood transfusions. These conditions, often characterized by diminished hemoglobin levels and increased bleeding risks, include coagulopathies, chronic and deficiency anemias, and fluid and electrolyte imbalances. Extensive data analysis supports this link, suggesting that blood loss, hemorrhage, shock, and gastrointestinal bleeding can all contribute to these imbalances and necessitate transfusions[19]. Our study further identified patients with metastatic cancer, peripheral vascular disorders, and pulmonary circulation disorders as at-risk patients. Chronic complications of diabetes can also increase transfusion risk. These conditions likely increase transfusion needs due to a combination of factors, including changes in blood vessel permeability, iron or protein deficiency anemia, and nutrient depletion associated with chronic illness.
This study revealed that patients who received perioperative blood transfusions incurred higher hospital costs and experienced longer hospital stays by approximately two days than did those who did not require transfusions. Previous research has established a link between blood transfusions and increased complication and mortality rates following various surgeries[20]. Our findings support these observations, demonstrating poorer patient outcomes associated with blood transfusions. Specifically, the study confirmed an increased risk of both medical and surgical complications following blood transfusion. Patients who underwent perioperative blood transfusions were more likely to develop complications such as thrombocytopenia, AMI, pneumonia, urinary tract infections, wound infections, postoperative delirium, and DVT.
This study possesses several limitations inherent to research utilizing large administrative databases such as the NIS. First, the NIS prioritizes the capture of healthcare utilization data, resulting in a dearth of clinically relevant details such as cervical cancer stage, blood loss volume, specific transfusion amounts, anesthesia types, and perioperative hemoglobin levels[19]. Although this absence limits our ability to delve into certain aspects, it does not impede the identification of potential risk factors. However, a significant strength of the NIS lies in its vast sample size, lending greater persuasiveness to the results. Consequently, the study findings provide valuable insights for optimizing care strategies for patients with invasive cervical cancer undergoing ARH. Second, the inpatient-centric nature of the NIS dataset presents a limitation. The database lacks variables encompassing long-term postdischarge complications, as it captures data for only the hospitalization period[12]. This means that complications arising after discharge or readmission remain unrecorded. Additionally, the possibility of coding inaccuracies or omissions related to surgical complications and transfusions exists. The accuracy of our transfusion analysis hinges on the precision and reliability of the utilized codes, highlighting the importance of ensuring accurate coding practices. Finally, as with all observational studies, inherent limitations exist despite our efforts to balance patient groups based on identifiable variables. Unaccounted factors that could influence outcomes remain a possibility. While ARH served as the primary focus of observation, with invasive cervical cancer as a prerequisite for inclusion, the NIS lacks details concerning surgeon identity or surgical duration. Although some degree of bias may be present, the large sample size helps to mitigate its potential impact on the study's conclusions.