Perioperative red blood cell transfusion in gallbladder cancer surgery: Trends and determinants from nationwide data

Abstract

Backgrounds/Aims: Gallbladder and biliary tract cancers (GBCs) are rare malignancies with poor prognoses, and surgical resection remains the only curative intervention. This study examined perioperative red blood cell (RBC) transfusion patterns among GBC patients in Korea and explored clinical and sociodemographic determinants associated with transfusion. Methods: Utilizing National Health Insurance Service (NHIS) data from 2012 to 2020, we identified 20,564 patients with GBC. Associations between perioperative RBC transfusion and various sociodemographic and clinical characteristics were assessed. Trends in transfusion rates were analyzed using the average annual percentage change (AAPC). Results: Of the cohort, 6,795 (33.0%) received perioperative RBC transfusions, with a mean age of 70.1 years. Increased likelihood of transfusion was observed among females, individuals with low income, and those residing outside metropolitan areas. Treatment in non-tertiary hospitals, higher Charlson comorbidity index, undergoing multiple surgical procedures, and the presence of extrahepatic cholangiocarcinoma were significantly correlated with transfusion. The transfusion rate declined from 38.4% in 2012 to 29.9% in 2020 (AAPC = -3.2, 95% confidence interval [95% CI]: -3.7, -2.8), with consistent reductions observed across all age groups and a marked decrease for cholecystectomy (AAPC = -7.2, 95% CI: -9.4, -5.0). Conclusions: Perioperative RBC transfusion rates in patients with GBC have declined over the past decade. Nevertheless, women, patients with lower income, and those managed at non-tertiary hospitals continue to receive transfusions at higher rates.