Blood transfusions in radical prostatectomy: a contemporary population-based analysis

Area of Science:

• Urology
• Surgical Oncology
• Transfusion Medicine

Background:

• Radical prostatectomy (RP) can necessitate blood transfusions, impacting patient outcomes.
• Understanding transfusion trends in open RP (ORP) versus minimally invasive RP (MIRP) is crucial for optimizing patient care.
• Homologous blood transfusion (HBT), autologous blood transfusion (ABT), and intraoperative blood conservation techniques (IOBCT) are key considerations.

Purpose of the Study:

• To analyze the rates and trends of HBT, ABT, and IOBCT in ORP and MIRP.
• To identify factors influencing transfusion practices during RP.

Main Methods:

• Analysis of the Nationwide Inpatient Sample database (1998-2007).
• Multivariable logistic regression models were employed to assess transfusion types.
• Covariables included annual hospital caseload (AHC), surgical year, patient age, comorbidity index, and region.

Main Results:

• A total of 119,966 patients undergoing RP were analyzed.
• Overall HBT, ABT, and IOBCT rates were 6.2%, 6.0%, and 1.2%, respectively.
• ABT rates significantly decreased (9.4% to 2.7%), while IOBCT rates also declined (1.9% to 0.9%). HBT rates remained stable (5.1%).
• ORP patients at lower AHC institutions had higher HBT rates.
• MIRP patients, regardless of AHC, had lower HBT rates compared to ORP patients at high AHC institutions.

Conclusions:

• The overall transfusion rate in RP has decreased, primarily driven by a substantial reduction in ABT.
• MIRP is associated with a lower risk of HBT, offering a protective effect even in centers with lower annual caseloads.