Hypovolemic phlebotomy in liver surgery is associated with decreased red blood cell transfusion. Issue 6 (June 2019)

• Record Type: Journal Article
• Authors: Baker, Laura; Bennett, Sean; Rekman, Janelle; Workneh, Aklile; Wherrett, Christopher; Abou-Khalil, Jad; Bertens, Kimberly A.; Balaa, Fady K.; Martel, Guillaume
• Is Part Of: HPB. Volume 21:Issue 6(2019)
• Page Start: 757
• Page End: 764
• Publication Date: 2019-06
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1016/j.hpb.2018.11.002
• Languages: English
• ISSNs: 1365-182X

Abstract

Abstract: Background: Perioperative red blood cell (RBC) transfusion is associated with poor outcomes in liver surgery. Hypovolemic phlebotomy (HP) is a novel intervention hypothesized to decrease transfusion requirements. The objective of this study was to examine this hypothesis. Methods: Consecutive patients who underwent liver resection at one institution (2010–2016) were included. Factors found to be predictive of transfusion on univariate analysis and those previously published were modeled using multivariate logistic regression. Results: A total of 361 patients underwent liver resection (50% major). HP was performed in 45 patients. Phlebotomized patients had a greater proportion of primary malignancy (31% vs 18%) and major resection (84% vs 45%). Blood loss was significantly lower with phlebotomy in major resections (400 vs 700 mL). Nadir central venous pressure was significantly lower with HP (2.5 vs 5 cm H2 O). On multivariate logistic regression, HP (OR 0.20, 95% CI 0.068–0.57, p = 0.0029), major liver resection (OR 2.91, 95% CI 1.64–5.18, p = 0.0003), preoperative hemoglobin < 125 g/L (OR 6.02, 95% CI 3.44–10.56, p < 0.0001), and underlying liver disease (OR 2.24, 95% CI 1.27–3.95, p = 0.0051) were significantly associated with perioperative RBC transfusion. Conclusion: Hypovolemic phlebotomy appears to be strongly associated with a reduction in RBC transfusion requirements in liver resection, independent of other known risk factors.