MP70-06 BLOOD TRANSFUSION AND TIMING FOLLOWING OPEN AND MINIMALLY INVASIVE NEPHRECTOMY

Abstract

You have accessJournal of UrologyKidney Cancer: Surgical Therapy V1 Apr 2015MP70-06 BLOOD TRANSFUSION AND TIMING FOLLOWING OPEN AND MINIMALLY INVASIVE NEPHRECTOMY Ruben Pinkhasov, Ariel Schulman, Zuhair Alhussaini, Mark Cogburn, Ciril Godec, and David Silver Ruben PinkhasovRuben Pinkhasov More articles by this author , Ariel SchulmanAriel Schulman More articles by this author , Zuhair AlhussainiZuhair Alhussaini More articles by this author , Mark CogburnMark Cogburn More articles by this author , Ciril GodecCiril Godec More articles by this author , and David SilverDavid Silver More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2531AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Current minimally invasive nephrectomy (laparoscopic and robot-assisted) may offer lower operative blood loss and reduced need for transfusion. The purpose of this study is to compare contemporary trends in blood transfusion and timing of open and minimally invasive nephrectomy using a national outcomes database. METHODS Using American College of Surgeons National Surgical Quality Improvement Project (NSQIP) database from 2005 to 2012, we analyzed patients who received blood transfusion in the perioperative period undergoing open or minimally invasive nephrectomy (MIN). Outcomes of interest were need and timing of perioperative blood transfusion (PBT) categorized into early (post-operative day ≤ 1) or late (post-operative day ≥ 2). Logistic regression analysis was used to identify variables associated with the need and timing for PBT. RESULTS Of the 12,684 patients that were analyzed, N=2,904 (22.9%) underwent open radical nephrectomy, N=2,387 (18.8%) open partial nephrectomy, N=4,428 (34.9%) laparoscopic radical nephrectomy, and N=2,965 (23.4%) laparoscopic partial nephrectomy. Overall, PBT rate was 10.1% (N=1,283). Open radical nephrectomy was 4.8 (95% CI: 4.1-5.5) times more likely to have bleeding complication that required transfusion than laparoscopic radical nephrectomy. Whereas open partial nephrectomy was 2.8 (95% CI: 2.3-3.5) times more likely to have bleeding complication requiring transfusion than laparoscopic partial nephrectomy. Open nephrectomy was 1.5 (95% CI: 1.1-2.1) times more likely to be transfused early (POD ≤ 1), compared to MIN. Still 14.3% of open nephrectomy and 20.2% of MIN patients required late (POD ≥ 2) transfusion. On logistic regression analysis significant predictors of transfusion included preoperative dyspnea (OR: 1.7; p<0.001), starting hematocrit <42 (OR: 1.4; p<0.001), open nephrectomy (OR 1.3; p <0.001), operative time (OR 0.9; p<0.001) and year of surgery (OR 0.9; p=0.028). Predictors that were not associated with transfusion included history of bleeding disorder (OR 3.6; p = 0.252), and resident involvement (OR 1.1; p=0.289). CONCLUSIONS Overall, perioperative blood transfusion rate is low. Radical or partial open nephrectomy is more likely to require transfusion and to be transfused early than MIN. Preoperative dyspnea, starting hematocrit <42, open nephrectomy, operative time, and year of surgery are significant predictors requiring transfusion. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e877 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ruben Pinkhasov More articles by this author Ariel Schulman More articles by this author Zuhair Alhussaini More articles by this author Mark Cogburn More articles by this author Ciril Godec More articles by this author David Silver More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...