A Reaffirm on Interpretation of Postoperative Anemia. A Valid Strategy to Limit Blood Transfusions after Hepatectomy for Liver Tumors

Abstract

Purpose: Hepatectomy is the most effective treatment for several malignant diseases but may be associated with blood loos and need for red blood cell transfusions (RBCT). However, the need for RBCT relies on the interpretation of postoperative anemia and on the transfusions policy locally adopted. The purpose of this study was to investigate the risk of RBCT, the associated trend of postoperative anemia, and the associations of RBCT with the range of complexity of hepatectomies. Methods: Data from all consecutive patients treated at our center were retrospectively reviewed. Both transfused and not transfused patients were considered. Blood loss and RBCT, hematocrit and hemoglobin levels in postoperative-day (POD) 1, 3, 5 and 7 were systematically analyzed. Complexity of operations was analyzed by using the CLISCO group classification. Results: Between 1998 and 2019, 1476 patients without missing data were considered. Of these, 174 (11.7%) patients were transfused. The hematocrit and hemoglobin levels were significantly lower in POD3 in comparison with POD1, POD5 and POD7 both in the transfused (P<0.001) and not transfused patients (P<0.001) (Figure 1) with a spontaneous increase from POD5. A statistically significant association was found between blood loss and RBCT with the complexity of hepatectomies (P<0.001). Conclusions: Drop in postoperative hemoglobin and hematocrit levels after hepatectomy is associated with increase from POD5 both in transfused and not transfused patients. Such phenomenon allows for restrictive RBCT, which should be limited to complex operations or symptomatic or multi-morbidity patients.