Utility of Postoperative Serial Renal Function Monitoring in Patients Undergoing Radical Cystectomy for Urothelial Carcinoma

Bitcon, Christopher; Whalen, Stewart; Coleman, Jenna; Rendon, Ricardo; Bailly, Greg; Bell, David; Cox, Ashley; Duplisea, Jon; Tenankore, Karthik; Mason, Ross

doi:10.1245/s10434-022-11667-1

Cited by 2 publications

(2 citation statements)

References 14 publications

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“…In this same population, we have previously shown prolonged postoperative serum creatinine monitoring to be of little clinical utility. 8 In our study population a total of 3317 sHgb measurements were done. The median number of measurements per patient was 9, closely mirroring the median LOS of 10 days.…”

confidence: 99%

Clinical utility of routine postoperative serial hemoglobin measurements in patients undergoing radical cystectomy for urothelial carcinoma

Whalen¹,

Rendon

Bell³

et al. 2022

CUAJ

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Introduction: Routine measurements of serum hemoglobin (sHgb) are common after abdominal surgery; however, prolonged measurements may be associated with patient anxiety, increased costs, and longer hospitalization without clinical benefit. The objective of this study was to determine the utility of routine sHgb measurements after radical cystectomy (RC) and factors associated with transfusion of packed red blood cell (pRBC) beyond postoperative day (POD) 2. Methods: We retrospectively reviewed patients who underwent RC between 2009 and 2019 at a single academic tertiary care center. The number of sHgb measurements for each patient was examined and pRBC transfusion rates were calculated. Multivariable logistic regression was used to determine factors associated with transfusion beyond POD 2. Results: The median number of sHgb measurements per patient during admission was 9 (interquartile range [IQR] 7,25). Overall, 69/240 (28.7%) patients received a postoperative transfusion, including 46/240 (19.2%) patients receiving a transfusion beyond POD 2. Among patients with a sHgb >100 g/L on POD 2, 7/85 (8.2%) went on to receive a transfusion beyond this day compared with 39/155 (25.2%) patients with sHgb <100 g/L. On multivariable analysis, risk factors associated with pRBC transfusion beyond POD 2 included older age, lower sHgb on POD 2, and longer length of stay in hospital. Conclusions: Transfusion of PRBCs beyond POD2 was found to be common; however, patients with sHgb >100 g/L on POD 2 were at low risk of requiring subsequent transfusion. Discontinuing further routine sHgb checks in these patients may serve to decrease patient anxiety, healthcare costs, and delays in hospital discharge.

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confidence: 99%

Clinical utility of routine postoperative serial hemoglobin measurements in patients undergoing radical cystectomy for urothelial carcinoma

Whalen¹,

Rendon

Bell³

et al. 2022

CUAJ

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“…These protocols have been shown to reduce length of stay while preserving quality of care [5][6][7] . Many surgical specialities are beginning to look at perioperative optimization through reduction of unnecessary blood tests, and urology is no exception [8][9][10][11][12] . Identification of patients at low risk of complications is crucial to avoid unnecessary intervention while also preserving perioperative outcomes.…”

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confidence: 99%

Examining the utility of routine perioperative hemoglobin monitoring in patients undergoing radical nephrectomy

Gillis,

Sherazi,

Rendon

et al. 2024

CUAJ

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Introduction: Patients undergoing radical nephrectomy (RN) are often admitted with protocolized bloodwork for several days following their operation, yet the clinical value of serial hemoglobin (Hgb) measurements has not been established. This can lead to unnecessary costs and can prolong patient stay, despite the absence of an intervention based on these lab values. This study sought to examine perioperative Hgb values and identify those patients at high risk of bleeding requiring intervention, as well as those patients who are unlikely to require further monitoring. Methods: Patient and perioperative factors were retrospectively examined for a cohort of 259 radical nephrectomy patients from 2015–2021 in Atlantic Canada. Postoperative Hgb values and transfusion rates were recorded. A multivariate logistic regression analysis was performed to identify variables associated with requiring a blood transfusion. Results: Overall, 31 (12%) patients required a blood transfusion in the postoperative period. Median estimated blood loss (EBL) was 150 ml (interquartile range [IQR] 100–300), with a median Hgb change of 15 g/L (IQR 9–22 g/L) from preoperative to postoperative day 1 (POD1). In patients with a Hgb loss of ≤15 g/L (n=131), transfusion was only required in four of these patients (3.1%). Among those with a POD1 Hgb >100 g/L (n=199), only four (2%) required transfusion. These patients were identified to be having complications based on hemodynamic instability. Factors found to be associated on multivariate regression analysis with higher transfusion risk were age and intraoperative EBL, while higher preoperative Hgb was found to be associated with a lower transfusion risk. Conclusions: In patients who have a reassuring POD1 Hgb value, with a drop of <15 g/L or an absolute value of >100 g/L, consideration can be made towards discontinuing routine Hgb testing in the absence of a clinical indication. Age, blood loss, and preoperative Hgb are factors that may affect a patient’s overall risk of transfusion.

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Utility of Postoperative Serial Renal Function Monitoring in Patients Undergoing Radical Cystectomy for Urothelial Carcinoma

Cited by 2 publications

References 14 publications

Clinical utility of routine postoperative serial hemoglobin measurements in patients undergoing radical cystectomy for urothelial carcinoma

Clinical utility of routine postoperative serial hemoglobin measurements in patients undergoing radical cystectomy for urothelial carcinoma

Examining the utility of routine perioperative hemoglobin monitoring in patients undergoing radical nephrectomy

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