Postoperative Transfusion in Geriatric Cancer Patients Is Associated with Short-Term Morbidity

Hendrick L, Alhassan S, Yeoh C, et al. Evaluating the Relationship Between Anemia, Transfusion, and Surgical Outcomes in Surgical Geriatric Cancer Patients: A National Study. J Am Coll Surg.  February 2026.

Geriatric cancer patients often have increased baseline anemia, however the relationship between anemia, transfusion, and outcomes in this group is unknown. In this study, more than 400,000 adult cancer patients undergoing surgery were analyzed using ACS-NSQIP data, including more than 100,000 patients older than 75 years. The most common operations were for lower GI, genitourinary, and hepatobiliary malignancies. 

Postoperative anemia requiring transfusion (PART) occurred in a subset of patients and was independently associated with a significantly increased risk of severe 30-day complications, with nearly a twofold increase in odds on multivariable analysis after adjustment for age, comorbidities, cancer type, and other perioperative factors. The association persisted in patients older than 75 years. 

In contrast, genitourinary and gynecologic cancers were associated with fewer severe complications, while discharge to inpatient rehabilitation and higher BMI were linked to worse outcomes.

Postoperative transfusion in geriatric cancer patients appears to be more than a surrogate for baseline anemia—it is independently associated with increased short-term morbidity, particularly in the oldest patients. These findings support aggressive preoperative optimization of anemia, thoughtful intraoperative blood conservation, and judicious transfusion practices in elderly oncologic patients. Structured risk assessment and perioperative planning are especially critical in this vulnerable population.