CORR Insights(®): Are Allogeneic Blood Transfusions Associated With Decreased Survival After Surgery for Long-bone Metastatic Fractures?

S ubstantial progress has been made in the medical management of patients with metastatic cancer of the bone, and patients are living longer with their cancers more than ever before. Still, metastatic bone disease remains a major source of morbidity and mortality for patients afflicted with advanced cancers of the breast, prostate, lung, kidney, thyroid, myeloma, and more. As the population in the United States ages, the prevalence of cancer is expected to rise. Presently, the prevalence of cancer is about 5 million cases per year. In 2015, more than 1.2 million people will receive a cancer diagnosis, most of whom will be older than 40 years of age. Approximately half of these newly diagnosed cases will involve the skeleton. As of 2007, the cost of treating metastatic bone cancer in the United States reached USD 12.6 billion, making up almost 20% of all societal cancer costs, as estimated by the NIH [6]. These numbers will continue to rise as the population ages, and are not restricted to the United States. Metastatic bone disease is a major global health care challenge [5]. Janssen and colleagues attempt to answer whether allogeneic blood transfusions are associated with worse survival after surgery in patients with pathologic long bone fractures. The current study poses a clear clinical question, which it tries to answer with a relatively large and homogeneous patient population while reviewing a robust number of clinical variables. This work is commendable for the volume of patients and clinical factors it evaluates. Additionally, it demonstrates statistically significant information apart from the primary objective that would be consistent with expectations. By their own admission, the work by Janssen and colleagues is underpowered to definitively demonstrate a lack of correlation between perioperative transfusions and patient survival. Still, it is hard to imagine a much larger or more thorough This CORR Insights is a commentary on the article ‘‘Are Allogeneic Blood Transfusions Associated With Decreased Survival After Surgery for Long-bone Metastatic Fractures? by Janssen and colleagues available at: DOI: 10.1007/s11999-015-4167-3. The author certifies that he, or a member of his immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/ licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR or the Association of Bone and Joint Surgeons. This CORR Insights comment refers to the article available at DOI: 10.1007/s11999-0154167-3. R. L. Randall MD (&) Sarcoma Services, Center for Children’s Cancer Research, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Suite 4260, Salt Lake City, UT 84112-5550, USA e-mail: lor.randall@hci.utah.edu CORR Insights Published online: 7 March 2015 The Association of Bone and Joint Surgeons1 2015