Outcomes After Intraoperative Hypovolemic Phlebotomy in Patients Undergoing Liver Surgery: A Meta-Analysis

Area of Science:

• Hepatobiliary Surgery
• Transfusion Medicine
• Surgical Hemostasis

Background:

• Significant blood loss is a major concern in liver surgery.
• Intraoperative hypovolemic phlebotomy (HP) has emerged as a strategy to mitigate blood loss and transfusion requirements.
• This meta-analysis evaluates the efficacy and safety of HP in liver surgery.

Purpose of the Study:

• To assess the impact of intraoperative hypovolemic phlebotomy (HP) on blood loss and transfusion rates in patients undergoing liver surgery.
• To compare HP with standard care in liver surgery settings.
• To analyze the safety profile of HP in this patient population.

Main Methods:

• A comprehensive meta-analysis of randomized controlled trials (RCTs) and observational studies.
• Searched major electronic databases (PubMed, Embase, Web of Science) up to November 2025.
• Employed a random effects model to pool data on perioperative red blood cell (RBC) transfusions, estimated blood loss, and safety outcomes.

Main Results:

• HP use was associated with a significant reduction in perioperative RBC transfusions (RR: 0.55).
• HP significantly decreased intraoperative (RR: 0.46) and postoperative (RR: 0.60) RBC transfusion rates.
• Estimated blood loss was reduced by an average of 237 mL with HP, with comparable safety outcomes and hospital stay duration.

Conclusions:

• Intraoperative hypovolemic phlebotomy (HP) is effective in reducing blood transfusion rates and blood loss during liver surgery.
• HP demonstrates an acceptable safety profile, with no significant increase in overall complications.
• Further research is warranted to elucidate the precise mechanisms underlying HP's benefits.