Comparative Analysis of Intra-Operative Transfusion Rates: Surgical Modality Comparison Using Japanese Real-World Database

OBJECTIVES: Minimally invasive surgery has been known to require less transfusion during the surgery as incision is not as large as traditional open surgery. In this study, we aim to provide more comprehensive overview of transfusion rate comparison across multiple procedures by analyzing nationwide real-world dataset.

METHODS: All Japanese patients who underwent prostatectomy, nephrectomy, rectal resection, lobectomy, hysterectomy or gastrectomy from April 1, 2018 to March 31 2021 were identified from Japan Medical Data Vision (MDV) database. We compared transfusion rates of the identified population by Open, laparoscopic (LAP) or video assisted thoracoscopic surgery (VATS), and robot assisted surgery (RAS) during patients’ hospitalization.

RESULTS: A total of 125,903 patients were identified. Transfusion rate of Open, LAP(lobectomy: VATS) and RAS was 68.43% (1322/1932), 23.64% (521/2204) and 7.04%(825/117718) in prostatectomy, 23.57%(657/2788), 7.9%(784/9929) and 3.96%(88/222) in nephrectomy, 10.54%(417/3956), 2.71%(491/18149), 1.86(14/753) in lobectomy, 32.66%(1948/5964), 9.06%(1775/19589), 5.78%(101/1748) in rectal resection, 24.84%(2501/10067), 2.86%(54/1890), 1.19%(4/336) in hysterectomy, and 29.39%(4745/16145), 8.34%(1246/14941), 6.8%(107/1574) in gastrectomy. Odds (CI) of Open and LAP compared to RAS is 28.6 (25.40-32.23) and 4.09 (3.62-4.61) for prostatectomy, 7.46(5.94-9.45) and 2.07(1.66-2.61) for nephrectomy, 6.15(3.73-11.07) and 1.45(0.88-2.61) for lobectomy, 7.90(6.45-9.78) and 1.62(1.33-2.00) for rectal resection, 26.39 (11.27-86.98) and 2.35(0.96-7.97) for hysterectomy, and 4.32(3.56-5.29) and 1.23(1.00-1.51) for gastrectomy.

CONCLUSIONS: RAS presented the lowest transfusion rates in all procedures. The effect of RAS in reducing transfusion was more evident in prostatectomy and hysterectomy where more transfusion is required during conventional surgeries. Depending on the procedure, the odds of open surgery group having transfusion was 4.32-28.6 times, while that of LAP was 1.23-4.09 times higher than RAS.