Blood transfusion and postoperative complications: a cautionary comment

In the recent issue of JAMA Surg, Ecker and coworkers (1) reported a large study aimed to evaluate trends in transfusion rates for major abdominal oncologic resections. This retrospective population-based study was using the American College of Surgeons National Surgical Quality Improvement Project database. Another study by Ferraris et al. (2) aimed to determine the role of transfusion for patients’ postoperative outcomes. This study was based on the same database. Ecker et al. (1) found transfusion was associated with occurrence of wound infection, renal insufficiency, and myocardial infarction. Ferraris et al (2) revealed that transfusion has a dose-dependent adverse effect on postoperative outcomes. Though some of these findings were confirmed by another population based study (3), we believe that some issues of these two articles require consideration.