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Optimization of low pre-operative hemoglobin reduces transfusion requirement in patients undergoing transurethral
1Section of Urology, Department of Surgery, The Aga Khan University, Karachi.
Insights
Peri-operative hemorrhage during transurethral resection of the prostate (TURP) is influenced by operative time and resected tissue weight. Low pre-operative hemoglobin is the only reversible factor to reduce transfusions.
Area of Science:
- Urology
- Surgical Oncology
- Anesthesiology
Background:
- Transurethral resection of the prostate (TURP) is a common procedure.
- Peri-operative hemorrhage is a significant complication of TURP, often necessitating blood transfusions.
- Identifying factors influencing hemorrhage is crucial for improving patient outcomes.
Purpose of the Study:
- To identify factors associated with peri-operative hemorrhage in patients undergoing TURP.
- To explore strategies for reducing the need for blood transfusions during and after TURP.
Main Methods:
- A retrospective review of 384 patients who underwent TURP between January 1997 and December 1999.
- Patients were categorized into two groups: those with significant hemorrhage and those without.
- Demographic, pre-operative, intra-operative, and post-operative data were analyzed.
Main Results:
- Nineteen patients experienced significant hemorrhage.
- Factors significantly associated with hemorrhage included longer operative time, greater resected tissue weight, and presentation with urinary retention.
- A pre-operative hemoglobin level of 10.6% correlated with a 37% transfusion rate.
Conclusions:
- Operative time and resected tissue weight are linked to hemorrhage but are not fully controllable.
- Maintaining adequate pre-operative hemoglobin levels is the primary modifiable factor for reducing transfusion requirements after TURP.
Objective:
To identify factors that influence peri-operative hemorrhage in view of reducing the need for transfusions in patients undergoing trans uretheral resection of prostate (TURP).
Methods:
All patients undergoing TURP between January 1997 and December 1999 were identified using ICD 9CM coding and indexing system. Overall 430 patients were identified, however, 384 charts were included and reviewed for demographics, pre and intra-operative data and post-operative morbidity. Patients were divided into two groups on the basis of presence of significant hemorrhage.
Results:
Overall 384 patients were analyzed. Nineteen patients had hemorrhage--group I whereas 365 had no significant hemorrhage--group II. Mean age and co-morbidities in the two groups were similar. However, in group I, 58% presented with urinary retention compared to 33% in group II. In group I, factors that reached statistical significance include; operative time (p<0.05), mean resected tissue weight (p<0.02), and patient presentation (urinary retention) (p<0.032). There was no significant difference in the two groups with respect to type of anesthesia (regional versus general) and histology of the resected tissue. Patients with mean pre-operative hemoglobin of 10.6 % had a 37% transfusion rate.
Conclusion:
Operative time, weight of resected prostate tissue are inter related and are only partly controllable. Low pre-operative hemoglobin is the only reversible factor in reducing transfusion following TURP.
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