Perioperative Blood Transfusion and Mortality After Pancreatic Surgery: A Nationwide Cohort Study With Propensity Score Matching

PURPOSE: This study aimed to evaluate the association between perioperative blood transfusion and postoperative mortality in patients undergoing pancreatic surgery. METHODS: This study used the Korean National Health Insurance Service database to identify patients who underwent pancreatic surgery (2012-2020). Transfusion was defined as the administration of ≥ 1 pack of whole blood or red blood cells within 7 days before to 30 days after surgery. Baseline characteristics were balanced using propensity score matching, and mortality risk was assessed using Cox proportional hazards models. Subgroup analyses were performed by surgical type. RESULTS: A total of 26 175 patients were included, and 36.1% received transfusion. After matching, mortality remained higher in the transfusion group (63.3% vs. 52.4%, p < 0.0001). Adjusted hazard ratios (aHRs) remained elevated across follow-ups: 45 days, 9.9 (95% CI, 1.0-96.1); 6 months, 3.0 (1.9-4.8); and 5 years, 1.4 (1.3-1.6). Subgroup analyses showed increased short- and long-term mortality risk in pancreaticoduodenectomy, with an overall aHR of 1.4 (1.2-1.6). In contrast, no long-term mortality risk was observed in distal pancreatectomy. CONCLUSIONS: Perioperative transfusion was associated with increased mortality after pancreatic surgery. These findings indicate the need for prudent transfusion practices and patient blood management strategies tailored to the surgical type to minimize transfusion-related risks.