Decreased use of red blood cell transfusion and associated factors for pancreatic cancer surgery.

Backgrounds/aims: This study investigated perioperative patterns of red blood cell (RBC) transfusion and related determinants in pancreatic cancer surgery using a nationwide Korean database.

Methods: We assessed data from the National Health Insurance Service (NHIS) from 2012 to 2020, including newly diagnosed pancreatic cancer patients aged ≥ 20 years who underwent pancreatic surgery within one-year of their diagnosis. Perioperative RBC transfusion was defined as receiving ≥ 1 unit of allogenic RBCs from one week before surgery through hospital discharge.

Results: Of the 10,473 patients, 18% underwent perioperative RBC transfusions. The transfusion rate declined from 20.1% in 2012 to 12.7% in 2015, followed by an increase to 19.9% in 2020. In a multivariate analysis, each 10-year increase in age (odds ratio [OR], 1.30; 95% confidence interval [CI], 1.24-1.37), female sex (OR, 1.16; 95% CI, 1.05-1.29), and being in the lowest-income quartile compared to the highest (OR, 1.29; 95% CI, 1.11-1.49) were associated with an increased likelihood of requiring RBC transfusions. A higher Charlson comorbidity index was independently connected to a greater risk as well. Compared with pancreaticoduodenectomy, total pancreatectomy had higher odds (OR, 1.91; 95% CI, 1.56-2.35), whereas distal pancreatectomy had lower odds. Furthermore, general hospitals, compared with tertiary hospitals, were associated with higher transfusion probability (OR, 1.38; 95% CI, 1.22-1.56).

Conclusions: Given rising RBC transfusion rates among low-income patients and limited NHIS coverage for new transfusion-sparing methods, Korea should prioritize broader adoption of multidisciplinary blood management over continued reliance on transfusion.