Patient blood management for liver resection: consensus statements using Delphi methodology.

Area of Science:

• Hepatobiliary Surgery
• Transfusion Medicine
• Anesthesiology

Background:

• Liver resection (LR) is associated with significant blood loss and transfusion requirements.
• Patient blood management (PBM) programs can improve outcomes and reduce costs but lack standardization for LR.
• This study aimed to develop an expert consensus statement on PBM for LR.

Purpose of the Study:

• To establish a standardized approach to Patient Blood Management (PBM) specifically for liver resection (LR).
• To create expert consensus recommendations covering the entire perioperative continuum for LR.

Main Methods:

• Modified Delphi methodology was employed with a multidisciplinary expert panel (35 participants).
• 28 statements regarding the three pillars of PBM were developed and iteratively rated anonymously over three rounds.
• Consensus was defined as at least 70% agreement, followed by an in-person meeting.

Main Results:

• Recommendations include pre-operative anemia assessment and management with iron supplementation.
• Intra-operative guidance emphasizes restrictive fluid administration, selective use of central lines, and specific surgical techniques.
• Specific criteria for restrictive transfusion strategies during and after surgery were established.

Conclusions:

• Patient blood management (PBM) for liver resection (LR) involves integrated medical and technical interventions across the perioperative period.
• Standardizing PBM for LR through these recommendations can enhance patient outcomes and optimize resource utilization.