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Radical retropubic prostatectomy and blood transfusion
Gregory A Nuttall1, Michael D Cragun, Darin L Hill
1Department of Anesthesiology, Mayo Clinic, Rochester, Minn 55905, USA. nuttall.gregory@mayo.edu
Mayo Clinic Proceedings
|December 14, 2002
Summary
Radical retropubic prostatectomy (RRP) blood loss and red blood cell (RBC) transfusions have significantly decreased over time. Improvements in surgical technique and transfusion guidelines contributed to this reduction in RBC transfusions.
Area of Science:
- Urology
- Surgical Oncology
- Transfusion Medicine
Background:
- Radical retropubic prostatectomy (RRP) is a major surgical procedure associated with potential blood loss.
- The incidence of allogeneic red blood cell (RBC) transfusions in RRP patients has historically been a concern.
Purpose of the Study:
- To evaluate trends in blood loss and RBC transfusion rates following RRP.
- To identify factors influencing transfusion incidence over time.
Main Methods:
- Retrospective analysis of 438 RRP cases performed between 1985 and 1999.
- Comparison of transfusion rates and mean RBC loss between patients who underwent the nerve-sparing dorsal venous complex (DVC) technique and those who did not.
- Assessment of preoperative and postoperative hemoglobin values and application of univariate and multivariate regression analyses.
Main Results:
- The allogeneic RBC transfusion rate for RRP decreased dramatically from 69% (1985-1986) to 7.1% (1999).
- Mean hemoglobin loss in the DVC technique group significantly reduced from 4.9 to 4.0 g/dL (P=.04) between 1985-1990, with this trend continuing in 1999.
- Discharge hemoglobin values declined from 12.0 to 10.9 g/dL during the study period.
Conclusions:
- Surgical technique advancements, including the DVC technique, have led to reduced blood loss during RRP.
- Lowered transfusion triggers and improved surgical skills have substantially decreased the need for RBC transfusions in RRP patients.