Impact of perioperative blood transfusion on thromboembolic events after radical cystectomy for muscle-invasive bladder cancer

Perioperative blood transfusion is frequently required during radical cystectomy (RC) for muscle-invasive bladder cancer. The aim of this study was to evaluate the impact of perioperative blood transfusion on the occurrence of postoperative venous thromboembolism (VTE) in patients undergoing RC for muscle-invasive bladder cancer. All patients who underwent open RC between 2015 and 2023 were reviewed. A venous thromboembolism was defined as either a deep venous thrombosis or pulmonary embolism. Patients who developed a VTE within 90 days after surgery were compared to those who did not. Logistic regression was performed to assess the association between covariates and the probability of VTE within 90 days after surgery. A total of 520 cases were enrolled in this study. One hundred seventy-five (33.65%) of patients developed a VTE within 90 days after surgery. Compared with patients who did not develop VTE, those who experienced postoperative VTE were significantly older ( p < 0.001), were more likely to be active smokers ( p < 0.001), and had a higher body mass index (BMI) ( p < 0.001). They also had larger tumors ( p < 0.001), were more likely to have undergone complete TURBT ( p < 0.001), and were more frequently treated with neoadjuvant chemotherapy ( p = 0.024). Additionally, these patients underwent longer surgical procedures ( p < 0.001), experienced greater intraoperative blood loss (> 450 mL) ( p < 0.001), and required perioperative blood transfusions ( p < 0.001), intraoperative tranexamic acid administration ( p = 0.001), or vasoactive agents ( p = 0.01) more often. Older age ( p = 0.002), higher BMI ( p = 0.008), greater intraoperative blood loss ( p = 0.001), and perioperative blood transfusion ( p = 0.007) remained independent predictors of postoperative VTE. The incidence of perioperative blood transfusion is significant at the time of radical cystectomy. This study demonstrates that blood transfusion was associated with an increased risk for developing the VTE.