Radical Retropubic Prostatectomy: Limited Benefit of Autologous Blood Donation

Goad, Jeremy; Eastham, James A.; Fitzgerald, Kevin B.; Kattan, Michael W.; Collini, Michael Patrick; Yawn, David H.; Scardino, Peter T.

doi:10.1016/s0022-5347(01)66706-5

Cited by 51 publications

(24 citation statements)

References 18 publications

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“…5 Although even patients who are being treated by the most experienced surgeons can have substantial blood loss, it is likely that more experienced surgeons will have lower blood loss on average than surgeons who have less experience with the procedure. 6,7 The number of packed red blood cells transfused has a higher correlation with total hospital costs (r ¼ 0.399, P < 0.001) than estimated blood loss (r ¼ 0.285, P < 0.01). This is likely due to the fact that units of blood transfused is a more sensitive indicator of the effect of blood loss on the patient than estimated blood loss.…”

Section: Discussionmentioning

confidence: 99%

The relationship between quality and costs: factors that affect the hospital costs of radical prostatectomy

Benoit

2001

Prostate Cancer Prostatic Dis

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The present study seeks to establish a relationship between the quality of a surgical procedure and the subsequent hospital costs for that procedure by investigating the influence of both patient and peri-operative factors on the hospital costs of radical prostatectomy. All men who underwent radical prostatectomy at one institution during an 18-month period were included in this study. Clinical information was obtained from medical records and cost information was obtained from hospital billing data. The medical record was also used to determine peri-operative information such as operating room time, anesthesia time, surgical time, blood loss and units of packed red blood cells transfused. The correlation between costs and both clinical and peri-operative factors were determined using the Pearson correlation co-efficient. One hundred and four men underwent radical prostatectomy at our institution during the time period studied. Mean age of these patients was 60.2 y and mean length of stay for these patients was 3.4 days with a range of 2 -10 days. Mean total hospital costs for this cohort was $5305 with a range of $2851 -$10 358. Significant correlations with total hospital costs included operating room time, surgical time, estimated blood loss and blood transfused. Patient factors such as age, ASA class, co-morbidities and smoking history were not correlated with total hospital costs. The present study demonstrates that factors at least partially controlled by the surgeon such as surgical time and units of blood transfused directly influence the total hospital costs of radical prostatectomy, while patient factors such as age and the presence of co-morbidities had no significant correlation with total hospital costs. These findings demonstrate that surgeons can impact health care costs by providing high quality care and begins to establish a relationship between high quality care and low cost care. Prostate Cancer and Prostatic Diseases (2001) 4, 213-216.

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Section: Discussionmentioning

confidence: 99%

The relationship between quality and costs: factors that affect the hospital costs of radical prostatectomy

Benoit

2001

Prostate Cancer Prostatic Dis

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“…The time of catheter drainage was equal in both groups. Operative blood loss was estimated by the anes thesiologist and was taken exclusively from anesthesia records, since the anesthesiologist estimates the operative blood loss best [14], The two-sided Fisher's exact test and two-tailed Mann-Whitney test were used for statistical evaluation.…”

Section: Patients and M Ethodsmentioning

confidence: 99%

Early Complication of Anatomical Radical Retropubic Prostatectomy: Lessons from a Single-Center Experience

et al. 1997

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Objectives: The purpose of this study is to report the rate of early complications in 316 of 600 patients who underwent anatomical radical retropubic prostatectomy for localized prostatic cancer from June 1988 to July 1996 and to measure the effect of increasing experience in a single institution. Methods: From January 1992 to August 1995, 316 patients with prostatic cancer underwent anatomical radical retropubic prostatectomy at our medical institution. Early complications were recorded prospectively and the rate of complications of the first 166 patients was compared with the rate in the next 150 patients. Results: Comparison of the 2 groups showed a significant decrease in blood loss with time (mean 1,397 vs. 967 cm3, p = 0.0011). The rates of anastomotic urinary leakage (21.7 vs. 10%, p = 0.0056), lymphoceles (22.3 vs. 2%, p < 0.0001), rectal injury (7.8 vs. 2%, p = 0.02), reoperation (10.2 vs. 4%, p = 0.049), and thromboembolic complications (7.8 vs. 2.7%, p = 0.0479) also decreased significantly. Only ureteral transsection showed an increase in the later group (0 vs. 4.7%, p = 0.005). Conclusions: The low percentage of early complications suggests that anatomical retropubic radical prostatectomy is a safe approach. Our single-center study showed a learning pattern that appears unavoidable when this operation is as radical as possible so as to keep the percentage of positive margins low especially in patients with advanced tumors ( > pT2).

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“…More recently mathematical studies of transfusion strategies have led to more correct estimates of surgical blood loss in RRP [4][5][6][7] (table 2). One report only has described a kind of equivalent WBL of 2,266 ml [6] while a calculated RBCL from 699 to 1,003 ml has been reported [4,5,7].…”

Section: Discussionmentioning

confidence: 99%

“…One report only has described a kind of equivalent WBL of 2,266 ml [6] while a calculated RBCL from 699 to 1,003 ml has been reported [4,5,7]. Given a mean perioperative HCT of about 39%, WBL could have been from 1,792 to 2,571 ml.…”

Section: Discussionmentioning

confidence: 99%

“…It is now suggested that RRP can be done with less allogeneic blood than expected [2,3]. Unfortunately, objective measures of blood loss are rare [4][5][6][7] and excessive emphasis tends to be put on estimated blood loss (EBL) and on the percentage of patients transfused with allogeneic packed red blood cells (PRBC; allogeneic blood transfusion rate). A mathematical approach to blood transfusion has now been proposed to calculate surgical blood loss using easily obtainable data [4,[7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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A Simple Mathematical Approach to Calculate Blood Loss in Radical Prostatectomy

Hurle

Poma²,

Maffezzini³

et al. 2004

Urol Int

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Introduction: The aim of this study was to apply a simple mathematical approach to calculate blood loss in 126 patients undergoing radical retropubic prostatectomy (RRP). Materials and Methods: Perioperative red blood cell loss (RBCL) was estimated by adding the difference in circulating red blood cells from before to after surgery to the allogeneic red blood cells transfused in the same period. Results: Mean preoperative hematocrit was 45 ± 4% and mean perioperative RBCL was 574 ± 297 ml, corresponding to a mean equivalent whole blood loss (WBL) of 1,479 ± 831 ml. Twenty of 126 patients (15.9%) received 42 units of allogeneic packed red blood cells (PRBC), for a mean of 2.1 ± 1.2 U/patient. The transfusion rate was higher in patients with a preoperative hematocrit of 40% or less (45 vs. 13%, p = 0.014). Conclusions: Anatomical RRP is still associated with appreciable operative blood loss. Owing to the high preoperative hematocrit values, the allogeneic blood transfusion rate is low and the transfusion requirement of the majority of patients is limited to about 2 units of PRBC. Preoperative autologous blood augmentation strategies may not be routinely needed for patients with a basal hematocrit of >40%.

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Radical Retropubic Prostatectomy: Limited Benefit of Autologous Blood Donation

Abstract: With decreasing blood loss, safe but stringent criteria for transfusion and improved safety of the blood supply, autologous donation is an inefficient method to lower the slight risk of complications following homologous transfusion during radical prostatectomy.

Cited by 51 publications

References 18 publications

The relationship between quality and costs: factors that affect the hospital costs of radical prostatectomy

The relationship between quality and costs: factors that affect the hospital costs of radical prostatectomy

Early Complication of Anatomical Radical Retropubic Prostatectomy: Lessons from a Single-Center Experience

A Simple Mathematical Approach to Calculate Blood Loss in Radical Prostatectomy

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